Provider Demographics
NPI:1245594043
Name:GLENVUE H&R NURSING LLC
Entity Type:Organization
Organization Name:GLENVUE H&R NURSING LLC
Other - Org Name:GLENVUE HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:P
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-869-5118
Mailing Address - Street 1:721 N VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-2208
Mailing Address - Country:US
Mailing Address - Phone:912-654-2138
Mailing Address - Fax:912-654-1518
Practice Address - Street 1:721 N VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-2208
Practice Address - Country:US
Practice Address - Phone:912-654-2138
Practice Address - Fax:912-654-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141171AMedicaid
GA00141171AMedicaid