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General NPI Number Information
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NPI Number | 1710140173
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Entity Type | Organization
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Legal Business Name | THE VILLAGE AT GLEANNLOCH FARMS, INC
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 08/12/2009
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Provider Practice Location Address
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Address Line | 9505 NORTHPOINTE BLVD
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City | SPRING
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State | TX
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Zip | 77379-3799
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Country | US
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Telephone | 281-430-4941
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Fax | 281-430-4907
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Provider Business Mailing Address
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Address Line | 9505 NORTHPOINTE BLVD
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City | SPRING
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State | TX
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Zip | 77379-3799
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Country | US
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Telephone | 281-430-4941
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Fax | 281-430-4907
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Authorized Official
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Title or Position | DIRECTOR OF HEALTH SERVICES
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Name | MR. TAB ALLEN WERNER
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Credential | LNFA
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Telephone | 281-430-4941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 127078
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 126881
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License Number State | TX
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