Provider Demographics
NPI:1003033861
Name:GLENWOOD CENTER LTD
Entity Type:Organization
Organization Name:GLENWOOD CENTER LTD
Other - Org Name:GLENWOOD BUILDING GROUP LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:CUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:815-968-5342
Mailing Address - Street 1:2823 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-3542
Mailing Address - Country:US
Mailing Address - Phone:815-968-5342
Mailing Address - Fax:815-968-4656
Practice Address - Street 1:2823 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-3542
Practice Address - Country:US
Practice Address - Phone:815-968-5342
Practice Address - Fax:815-968-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K46994Medicare PIN
215887Medicare PIN
K46995Medicare PIN