Provider Demographics
NPI:1649955931
Name:GLENOAKS RD HEALTHCARE LLC
Entity type:Organization
Organization Name:GLENOAKS RD HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-969-0254
Mailing Address - Street 1:1101 GLENOAKS RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2529
Mailing Address - Country:US
Mailing Address - Phone:931-684-8340
Mailing Address - Fax:931-684-2385
Practice Address - Street 1:1101 GLENOAKS RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2529
Practice Address - Country:US
Practice Address - Phone:931-684-8340
Practice Address - Fax:931-684-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility