MEDICARE: GLEN HEALTH & HOME MANAGEMENT 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	332B00000X	Durable Medical Equipment & Medical Supplies		IL

General Provider Information

NPI Number	:	1740287689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN HEALTH & HOME MANAGEMENT INC

Provider Business Mailing Address
First Line	:	5454 FARGO AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3210
Country	:	US
Telephone Number	:	847-674-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	5454 FARGO AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3210
Country	:	US
Telephone Number	:	847-674-5454
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SIDNEY GLENNER
Credential	:
Telephone Number	:	847-674-5454

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/09/2010

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