Provider Demographics
NPI:1780836718
Name:GLENWOOD HEALTHCARE AND REHAB
Entity Type:Organization
Organization Name:GLENWOOD HEALTHCARE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:217-637-2794
Mailing Address - Street 1:19330 S COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1834
Mailing Address - Country:US
Mailing Address - Phone:708-758-6200
Mailing Address - Fax:708-758-9563
Practice Address - Street 1:19330 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-1834
Practice Address - Country:US
Practice Address - Phone:708-758-6200
Practice Address - Fax:708-758-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0032839332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========801Medicaid