Provider Demographics
NPI:1861499170
Name:GLENMONT
Entity Type:Organization
Organization Name:GLENMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:THORNDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, MBA
Authorized Official - Phone:614-876-0084
Mailing Address - Street 1:4599 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9786
Mailing Address - Country:US
Mailing Address - Phone:614-876-0084
Mailing Address - Fax:614-876-7095
Practice Address - Street 1:4599 AVERY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9786
Practice Address - Country:US
Practice Address - Phone:614-876-0084
Practice Address - Fax:614-876-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0657016Medicaid
OH361991Medicare Oscar/Certification