Provider Demographics
NPI:1538172820
Name:GLENWOOD CHRISTIAN NURSING HOME INC.
Entity type:Organization
Organization Name:GLENWOOD CHRISTIAN NURSING HOME INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:DOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-975-5287
Mailing Address - Street 1:4630 PLAINFIELD AVENUE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-957-3957
Mailing Address - Fax:616-957-1556
Practice Address - Street 1:13030 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LAMONT
Practice Address - State:MI
Practice Address - Zip Code:49430-9999
Practice Address - Country:US
Practice Address - Phone:616-677-1243
Practice Address - Fax:616-677-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI704040314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9763OtherBLUE CROSS
MI2155291Medicaid
MI235355Medicare Oscar/Certification