MEDICARE: GLNV, 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
1	1041C0700X	Clinical Social Worker	09924	TX

General Provider Information

NPI Number	:	1558562959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLNV, INC.

Provider Business Mailing Address
First Line	:	3215 W ALBERTA RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-9635
Country	:	US
Telephone Number	:	956-630-4214
Fax Number	:	956-686-6949

Provider Business Practice Location Address
First Line	:	3215 W ALBERTA RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-9635
Country	:	US
Telephone Number	:	956-630-4214
Fax Number	:	956-686-6949

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	GILBERT B LOPEZ
Credential	:
Telephone Number	:	956-630-4214

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/22/2020

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