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General NPI Number Information
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NPI Number | 1649628769
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Entity Type | Organization
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Legal Business Name | GLEM HEALTH INC.
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 832 S DUNCAN DR
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City | TAVARES
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State | FL
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Zip | 32778-4044
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Country | US
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Telephone | 352-835-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 21701 ROLLINGWOOD TRL
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City | EUSTIS
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State | FL
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Zip | 32736-9751
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLENN FECHTENBURG
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Credential | RN
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Telephone | 352-835-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 233221
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299994223
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License Number State | FL
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