Healthcare Provider Details

I. General information

NPI: 1407736010
Provider Name (Legal Business Name): GLENN CARPENTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 OAKDALE AVE
TOLEDO OH
43605-3323
US

IV. Provider business mailing address

PO BOX 398
TOLEDO OH
43697-0398
US

V. Phone/Fax

Practice location:
  • Phone: 419-478-1542
  • Fax:
Mailing address:
  • Phone: 419-367-6834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberHRC-18-00004
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberHRC-18-00004
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: