Provider Demographics
NPI:1487033890
Name:GLIDEDOWAN LLC
Entity Type:Organization
Organization Name:GLIDEDOWAN LLC
Other - Org Name:ALL-AMERICAN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:585-454-1776
Mailing Address - Street 1:742 SOUTH CLINTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-454-1776
Mailing Address - Fax:585-454-4266
Practice Address - Street 1:742 SOUTH CLINTON AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-454-1776
Practice Address - Fax:585-454-4266
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLIDEDOWAN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-19
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04160909Medicaid