Glenwood Park, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

4 Issued in WV

Legal business name

GLENWOOD PARK, INC.

Practice address

1924 Glenwood Park Rd
Princeton, WV 24740-7969

Phone

(304) 425-8128

Fax

(304) 487-1338

NPI assigned

Oct 10, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Daniel W. Farley, CNHA

Title

Ceo / President / Administrator

Phone

(304) 425-8128

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• GlenWood Park Retirement Village Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205824646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1924 GLENWOOD PARK RD",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247407969",
            "telephone_number": "304-425-8128",
            "fax_number": "304-487-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1924 GLENWOOD PARK RD",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247407969",
            "telephone_number": "304-425-8128",
            "fax_number": "304-487-1338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENWOOD PARK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FARLEY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CEO / PRESIDENT / ADMINISTRATOR",
        "authorized_official_telephone_number": "304-425-8128",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WV",
            "license": "4",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003502000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GlenWood Park Retirement Village",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Paggy Gilley
• Sherry Mae Gilliand
• Katelyn Brooke Gilmore, MSN CNE RN
• Teyonce Glenn
• Glenwood Park Leasing Co., LLC
• Glenwood SNF LLC
• Crystal Goff
• Ashley Goins
• Cody Goins, DPT
• Pennie Faith Goins, APRN, FNP-BC

• Skilled Nursing Facility in Princeton, WV
• Providers in Princeton, WV by specialty
• Skilled Nursing Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.