Provider Demographics
NPI:1093943433
Name:GLENNWOOD HEALTHCARE INC
Entity Type:Organization
Organization Name:GLENNWOOD HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-341-4857
Mailing Address - Street 1:920 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3165
Mailing Address - Country:US
Mailing Address - Phone:918-341-4857
Mailing Address - Fax:918-341-9199
Practice Address - Street 1:1700 E 141ST ST
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-3807
Practice Address - Country:US
Practice Address - Phone:918-291-4230
Practice Address - Fax:918-291-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375148Medicare Oscar/Certification