Provider Demographics
NPI:1578571808
Name:GLEN ROSE MEDICAL CENTER NURSING HOME, LLC
Entity Type:Organization
Organization Name:GLEN ROSE MEDICAL CENTER NURSING HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-897-1448
Mailing Address - Street 1:1021 HOLDEN ST.
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-2099
Mailing Address - Country:US
Mailing Address - Phone:254-897-1448
Mailing Address - Fax:254-897-1486
Practice Address - Street 1:1021 HOLDEN ST.
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-2099
Practice Address - Country:US
Practice Address - Phone:254-897-1448
Practice Address - Fax:254-897-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
675572Medicare Oscar/Certification