Provider Demographics
NPI:1669675096
Name:THE GEORGE G. GLENNER ALZHEIMER'S FAMILY CENTERS, INC.
Entity Type:Organization
Organization Name:THE GEORGE G. GLENNER ALZHEIMER'S FAMILY CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/EXECUTIVE D
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:TARDE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:619-543-4700
Mailing Address - Street 1:2765 MAIN STREET, SUITE A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911
Mailing Address - Country:US
Mailing Address - Phone:619-543-4700
Mailing Address - Fax:619-295-1057
Practice Address - Street 1:335 SAXONY ROAD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-635-1895
Practice Address - Fax:760-436-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70282FMedicaid