Provider Demographics
NPI:1093885212
Name:GLENNWOOD ENTERPRISES, INC
Entity Type:Organization
Organization Name:GLENNWOOD ENTERPRISES, INC
Other - Org Name:HERITAGE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TIMBERLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-283-8124
Mailing Address - Street 1:402 W WHEATLAND RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4600
Mailing Address - Country:US
Mailing Address - Phone:972-283-8124
Mailing Address - Fax:
Practice Address - Street 1:402 W WHEATLAND RD
Practice Address - Street 2:SUITE 170
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4600
Practice Address - Country:US
Practice Address - Phone:972-283-8124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004870251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024180401Medicaid
TX459027Medicare ID - Type UnspecifiedPROVIDER NUMBER