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NPI Code Detail

MEDICARE: THE VILLAGE AT GLEANNLOCH FARMS, INC

MEDICARE: THE VILLAGE AT GLEANNLOCH FARMS, 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
1310400000XAssisted Living Facility127078TX
2314000000XSkilled Nursing Facility126881TX

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 : 1710140173
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE VILLAGE AT GLEANNLOCH FARMS, INC
Provider Business Mailing Address
First Line : 9505 NORTHPOINTE BLVD
Second Line :
City : SPRING
State : TX
Zip : 77379-3799
Country : US
Telephone Number : 281-430-4941
Fax Number : 281-430-4907
Provider Business Practice Location Address
First Line : 9505 NORTHPOINTE BLVD
Second Line :
City : SPRING
State : TX
Zip : 77379-3799
Country : US
Telephone Number : 281-430-4941
Fax Number : 281-430-4907
Authorized Official
Title or Position : DIRECTOR OF HEALTH SERVICES
Name : MR. TAB ALLEN WERNER
Credential : LNFA
Telephone Number : 281-430-4941
Provider Enumeration Date : 07/07/2008
Last Update Date : 08/12/2009

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Directions to “THE VILLAGE AT GLEANNLOCH FARMS, INC ” Practice Location

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