MEDICARE: GLENMARK LIMITED LIABILITY COMPANY I

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
1	314000000X	Skilled Nursing Facility	128	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2507257	OTHER	AETNA-HMO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000327692	OTHER	MOUNTAIN STATE BC/BS
4	282183	OTHER	UNITED - MAMSI

General Provider Information

NPI Number	:	1225074081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENMARK LIMITED LIABILITY COMPANY I

Provider Business Mailing Address
First Line	:	101 E STATE ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3109
Country	:	US
Telephone Number	:	610-925-4436
Fax Number	:	610-925-4351

Provider Business Practice Location Address
First Line	:	1000 LINCOLN DR
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-2304
Country	:	US
Telephone Number	:	610-925-4436
Fax Number	:	610-925-4351

Authorized Official
Title or Position	:	CORPORATE MANAGER
Name	:	JANE DROPESKEY
Credential	:
Telephone Number	:	610-925-4231

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	08/17/2018

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