Provider Demographics
NPI:1114254653
Name:GLENCARE ASSISTED LIVING, INC DBA GLENCARE OF SNOW HILL
Entity Type:Organization
Organization Name:GLENCARE ASSISTED LIVING, INC DBA GLENCARE OF SNOW HILL
Other - Org Name:GLENCARE OF SNOW HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNEGAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-275-0058
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0339
Mailing Address - Country:US
Mailing Address - Phone:910-275-0058
Mailing Address - Fax:910-275-0093
Practice Address - Street 1:210 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-9031
Practice Address - Country:US
Practice Address - Phone:910-275-0058
Practice Address - Fax:910-275-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility