Healthcare Provider Details

I. General information

NPI: 1881935617
Provider Name (Legal Business Name): GLENBEIGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 STATE ROUTE 45 N
ROCK CREEK OH
44084-9352
US

IV. Provider business mailing address

2863 STATE ROUTE 45 N P O BOX 298
ROCK CREEK OH
44084-9352
US

V. Phone/Fax

Practice location:
  • Phone: 440-563-3400
  • Fax: 440-563-9363
Mailing address:
  • Phone: 440-563-3400
  • Fax: 440-563-9363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number6713
License Number StateOH

VIII. Authorized Official

Name: MS. HELEN M PARK
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 440-710-3204