Provider Demographics
NPI:1053858951
Name:GLENDA'S CD SERVICE
Entity Type:Organization
Organization Name:GLENDA'S CD SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE FACILITATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:BERNICE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-952-8693
Mailing Address - Street 1:901 GRACELAND DR
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-3564
Mailing Address - Country:US
Mailing Address - Phone:276-952-8693
Mailing Address - Fax:
Practice Address - Street 1:901 GRACELAND DR
Practice Address - Street 2:
Practice Address - City:BASSETT
Practice Address - State:VA
Practice Address - Zip Code:24055-3564
Practice Address - Country:US
Practice Address - Phone:276-952-8693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management