Provider Demographics
NPI:1467869743
Name:GLENDALE HEALTHCARE LLC
Entity Type:Organization
Organization Name:GLENDALE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-889-5833
Mailing Address - Street 1:6320 W UNION HILLS DR
Mailing Address - Street 2:STE 1400B
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1096
Mailing Address - Country:US
Mailing Address - Phone:602-889-5833
Mailing Address - Fax:
Practice Address - Street 1:6320 W UNION HILLS DR
Practice Address - Street 2:STE 1400B
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1096
Practice Address - Country:US
Practice Address - Phone:602-889-5833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty