Provider Demographics
NPI:1235294547
Name:GLEN ARDEN, INC.
Entity Type:Organization
Organization Name:GLEN ARDEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-739-6700
Mailing Address - Street 1:214 HARRIMAN DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2422
Mailing Address - Country:US
Mailing Address - Phone:845-360-1200
Mailing Address - Fax:845-291-3833
Practice Address - Street 1:214 HARRIMAN DRIVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2410
Practice Address - Country:US
Practice Address - Phone:845-360-1200
Practice Address - Fax:845-291-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
NY3523303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01774056Medicaid
NY01774056Medicaid