Provider Demographics
NPI:1811144363
Name:GLENCARA INC
Entity type:Organization
Organization Name:GLENCARA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-454-9804
Mailing Address - Street 1:8605 218TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1922
Mailing Address - Country:US
Mailing Address - Phone:718-454-9804
Mailing Address - Fax:718-454-9806
Practice Address - Street 1:8605 218TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1922
Practice Address - Country:US
Practice Address - Phone:718-454-9804
Practice Address - Fax:718-454-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR 15236251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12151001OtherHIP
12151001OtherMULTIPLAN
NY7405842OtherGHI
NY87726OtherINITED BEHAVIORAL HEALTH
NY02448819Medicaid
NYMHS237632OtherVALUE OPTIONS
NYP00472672OtherRAILROAD MEDICARE
NYP00472672OtherRAILROAD MEDICARE