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General NPI Number Information
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NPI Number | 1164581203
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Entity Type | Individual
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Provider Name | LINDA C. GLASGOW CEO
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2206 EMERYWOOD RD
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City | GREENSBORO
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State | NC
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Zip | 27403-3765
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Country | US
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Telephone | 336-297-5025
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Fax |
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Provider Business Mailing Address
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Address Line | 2206 EMERYWOOD RD
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City | GREENSBORO
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State | NC
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Zip | 27403-3765
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Country | US
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Telephone | 336-297-5025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | MHL-041-795
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License Number State | NC
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