Provider Demographics
NPI:1861820540
Name:GLADE GARDEN INC
Entity Type:Organization
Organization Name:GLADE GARDEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDZIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-507-1934
Mailing Address - Street 1:5860 91ST AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4910
Mailing Address - Country:US
Mailing Address - Phone:727-258-4537
Mailing Address - Fax:727-544-2716
Practice Address - Street 1:5860 91ST AVE N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4910
Practice Address - Country:US
Practice Address - Phone:727-258-4537
Practice Address - Fax:727-544-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12375310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility