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NPI Code Detail

MEDICARE: GLENWOOD PARK, INC.

MEDICARE: GLENWOOD PARK, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility4WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205824646
Entity Type Code : Organization
Provider Name (Legal Business Name) : GLENWOOD PARK, INC.
Provider Business Mailing Address
First Line : 1924 GLENWOOD PARK RD
Second Line :
City : PRINCETON
State : WV
Zip : 24740-7969
Country : US
Telephone Number : 304-425-8128
Fax Number : 304-487-1338
Provider Business Practice Location Address
First Line : 1924 GLENWOOD PARK RD
Second Line :
City : PRINCETON
State : WV
Zip : 24740-7969
Country : US
Telephone Number : 304-425-8128
Fax Number : 304-487-1338
Authorized Official
Title or Position : CEO / PRESIDENT / ADMINISTRATOR
Name : MR. DANIEL W. FARLEY
Credential : CNHA
Telephone Number : 304-425-8128
Provider Enumeration Date : 10/10/2005
Last Update Date : 08/22/2020

Similar Medicare Providers

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Practice Location Address:
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1548904121 — MRS. TINA RANAE GRAHAM PTA
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24739-7969
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Practice Fax:
1174267751 — CODY BLAKE DILLON PTA
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1134863947 — MRS. JENNIFER SUZANNE BLANKENSHIP RN
Practice Location Address:
1908 GLENWOOD PARK RD
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24739-7969
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