Provider Demographics
NPI:1235836602
Name:GLINECO RESIDENTIAL SERVICE
Entity Type:Organization
Organization Name:GLINECO RESIDENTIAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:GLINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-379-5268
Mailing Address - Street 1:4873 KLEEMAN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1991
Mailing Address - Country:US
Mailing Address - Phone:513-379-5268
Mailing Address - Fax:513-481-7900
Practice Address - Street 1:7194 PIPPIN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4605
Practice Address - Country:US
Practice Address - Phone:513-379-5268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care