Healthcare Provider Details

I. General information

NPI: 1861499170
Provider Name (Legal Business Name): GLENMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4599 AVERY RD
HILLIARD OH
43026-9786
US

IV. Provider business mailing address

4599 AVERY RD
HILLIARD OH
43026-9786
US

V. Phone/Fax

Practice location:
  • Phone: 614-876-0084
  • Fax: 614-876-7095
Mailing address:
  • Phone: 614-876-0084
  • Fax: 614-876-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. SARA FAYE THORNDIKE
Title or Position: ACCOUNTANT
Credential: CPA, MBA
Phone: 614-876-0084