Provider Demographics
NPI:1952563009
Name:GLENWOOD PLACE LLC
Entity Type:Organization
Organization Name:GLENWOOD PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:DESCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-752-8410
Mailing Address - Street 1:2907 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4687
Mailing Address - Country:US
Mailing Address - Phone:641-752-8410
Mailing Address - Fax:641-752-8515
Practice Address - Street 1:2907 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4687
Practice Address - Country:US
Practice Address - Phone:641-752-8410
Practice Address - Fax:641-752-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0086310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility