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General NPI Number Information
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NPI Number | 1770538290
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Entity Type | Organization
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Legal Business Name | GLEN OAKS CONVALESCENT CENTER
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 1101 GLEN OAKS ROAD
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City | SHELBYVILLE
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State | TN
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Zip | 37160
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Country | US
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Telephone | 931-684-8340
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Fax | 931-685-4113
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Provider Business Mailing Address
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Address Line | 1101 GLEN OAKS ROAD
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City | SHELBYVILLE
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State | TN
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Zip | 37160
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Country | US
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Telephone | 931-684-8340
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Fax | 931-685-4113
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MRS. JUDY A. BENNETT
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Credential |
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Telephone | 931-684-8340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0000000007
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License Number State | TN
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