Provider Demographics
NPI:1518138593
Name:GNP COUNTRY ESTATES LLC
Entity Type:Organization
Organization Name:GNP COUNTRY ESTATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEBKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:715-213-6379
Mailing Address - Street 1:1610 25TH AVE S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-4820
Mailing Address - Country:US
Mailing Address - Phone:715-423-1610
Mailing Address - Fax:715-423-1611
Practice Address - Street 1:1610 25TH AVE S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-4820
Practice Address - Country:US
Practice Address - Phone:715-423-1610
Practice Address - Fax:715-423-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility