Healthcare Provider Details

I. General information

NPI: 1699488734
Provider Name (Legal Business Name): GLENDAS GARDEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 AUBURN HILLS DR
RALEIGH NC
27616-9309
US

IV. Provider business mailing address

4361 AUBURN HILLS DR
RALEIGH NC
27616-9309
US

V. Phone/Fax

Practice location:
  • Phone: 919-348-7775
  • Fax:
Mailing address:
  • Phone: 919-348-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. ADRIENNE JOHNSON
Title or Position: OWNER
Credential:
Phone: 919-348-7775