Provider Demographics
NPI:1265690150
Name:GLENWOOD INC
Entity Type:Organization
Organization Name:GLENWOOD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-969-2880
Mailing Address - Street 1:150 GLENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5700
Mailing Address - Country:US
Mailing Address - Phone:205-969-2880
Mailing Address - Fax:205-795-3390
Practice Address - Street 1:150 GLENWOOD LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5700
Practice Address - Country:US
Practice Address - Phone:205-969-2880
Practice Address - Fax:205-795-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2731225X00000X
AL2279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528903380Medicaid