Provider Demographics
NPI:1275614497
Name:THE GLEN RETIREMENT SYSTEM
Entity Type:Organization
Organization Name:THE GLEN RETIREMENT SYSTEM
Other - Org Name:GLEN OAKS RETIREMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-798-3500
Mailing Address - Street 1:403 E FLOURNOY LUCAS RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3906
Mailing Address - Country:US
Mailing Address - Phone:318-798-3500
Mailing Address - Fax:318-798-7988
Practice Address - Street 1:1524 GLEN OAK PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3816
Practice Address - Country:US
Practice Address - Phone:318-221-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1510394Medicaid
LA195558Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER