Provider Demographics
NPI:1669988135
Name:KADIE GLEN ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:KADIE GLEN ASSISTED LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCHNEUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-204-8672
Mailing Address - Street 1:29 S VIA LOS ALTOS
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-7006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:451 N BAKER AVE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4857
Practice Address - Country:US
Practice Address - Phone:509-884-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility