Provider Demographics
NPI:1417131954
Name:GLOECKNER WEBER, LLC
Entity Type:Organization
Organization Name:GLOECKNER WEBER, LLC
Other - Org Name:STARS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-970-1904
Mailing Address - Street 1:536 PANTOPS CTR
Mailing Address - Street 2:PMB 338
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8665
Mailing Address - Country:US
Mailing Address - Phone:434-970-1904
Mailing Address - Fax:
Practice Address - Street 1:517 PARK ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4739
Practice Address - Country:US
Practice Address - Phone:434-970-1904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS-203-05320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities