Provider Demographics
NPI:1366498941
Name:EAST GLEN, LLC
Entity Type:Organization
Organization Name:EAST GLEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REGULATORY AFFAIRS
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-783-8472
Mailing Address - Street 1:600 CORPORATE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2934
Mailing Address - Country:US
Mailing Address - Phone:205-783-8460
Mailing Address - Fax:205-783-8450
Practice Address - Street 1:53 MEDICAL PARK DRIVE, EAST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3402
Practice Address - Country:US
Practice Address - Phone:205-836-4231
Practice Address - Fax:205-838-5327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOLAND HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12566314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47580505Medicaid
AL01-5388Medicare ID - Type Unspecified
AL47580505Medicaid