Provider Demographics
NPI:1134102809
Name:GLENBROOK HC LLC
Entity Type:Organization
Organization Name:GLENBROOK HC LLC
Other - Org Name:GLENBROOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELWOOD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:760-704-6255
Mailing Address - Street 1:1950 CALLE BARCELONA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8401
Mailing Address - Country:US
Mailing Address - Phone:760-704-6500
Mailing Address - Fax:760-704-6806
Practice Address - Street 1:1950 CALLE BARCELONA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8401
Practice Address - Country:US
Practice Address - Phone:760-704-6500
Practice Address - Fax:760-704-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-27
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000786314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555806Medicare Oscar/Certification