Provider Demographics
NPI:1720221633
Name:GLYNNIS LLC
Entity Type:Organization
Organization Name:GLYNNIS LLC
Other - Org Name:GLYNNIS PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORISTEEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:623-694-8075
Mailing Address - Street 1:4725 N 103RD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5023
Mailing Address - Country:US
Mailing Address - Phone:623-694-8075
Mailing Address - Fax:
Practice Address - Street 1:4216 N 100TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5914
Practice Address - Country:US
Practice Address - Phone:623-694-8075
Practice Address - Fax:623-321-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility