Provider Demographics
NPI:1336417633
Name:GLESENER'S, INC.
Entity Type:Organization
Organization Name:GLESENER'S, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:GLESENER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:320-365-3823
Mailing Address - Street 1:160 SOUTH MAIN STREET
Mailing Address - Street 2:PO BOX 140
Mailing Address - City:BIRD ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55310-0140
Mailing Address - Country:US
Mailing Address - Phone:320-365-3823
Mailing Address - Fax:320-365-3361
Practice Address - Street 1:160 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BIRD ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55310-0140
Practice Address - Country:US
Practice Address - Phone:320-365-3823
Practice Address - Fax:320-365-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN352876251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA827324300OtherMINNESOTA UMPI