Provider Demographics
NPI:1275697658
Name:BLC GLENWOOD GARDENS SNF LH LLC
Entity Type:Organization
Organization Name:BLC GLENWOOD GARDENS SNF LH LLC
Other - Org Name:BROOKDALE RIVERWALK SNF (CA)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LESKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:350 CALLOWAY DR
Mailing Address - Street 2:BUILDING 'C'
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2974
Mailing Address - Country:US
Mailing Address - Phone:661-587-0182
Mailing Address - Fax:661-587-8053
Practice Address - Street 1:350 CALLOWAY DR
Practice Address - Street 2:BUILDING 'C'
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2974
Practice Address - Country:US
Practice Address - Phone:661-587-0182
Practice Address - Fax:661-587-8053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000555314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55771GMedicaid
CALTC55771GMedicaid