Provider Demographics
NPI:1932157708
Name:GLENWOOD ESTATE, INC.
Entity Type:Organization
Organization Name:GLENWOOD ESTATE, INC.
Other - Org Name:REGAL ESTATE OF GLENWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-331-8789
Mailing Address - Street 1:1000 MULBERRY ST
Mailing Address - Street 2:P.O. BOX 627
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-2026
Mailing Address - Country:US
Mailing Address - Phone:620-331-8789
Mailing Address - Fax:620-331-6895
Practice Address - Street 1:1000 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-2026
Practice Address - Country:US
Practice Address - Phone:620-331-8789
Practice Address - Fax:620-331-6895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLENWOOD ESTATE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-04
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN063017313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS800OtherBLUE CROSS BLUE SHIELD
KS100108260AMedicaid
KS100108260AMedicaid