Active NPI
East Glen, LLC
- Skilled Nursing Facility
- Birmingham, AL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 12566
- Legal business name
- EAST GLEN, LLC
- Practice address
- 53 Medical Park Drive, East
Birmingham, AL 35235-3402 - Phone
- (205) 836-4231
- Fax
- (205) 838-5327
- NPI assigned
- May 26, 2006
- Organization subpart
- Yes
- Parent organization
- NOLAND HEALTH SERVICES, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nicholas V Renda
- Title
- Evp/Cfo
- Phone
- (205) 783-8460
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 12566 | AL | Primary |
Addresses
Primary practice location
53 Medical Park Drive, East
Birmingham, AL 35235-3402
Mailing address
600 Corporate Pkwy
Suite 100
Birmingham, AL 35242-2934
Phone (205) 783-8460
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47580505 | Medicaid | AL |
Other names 1
- East Glen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060803000083 | AL | Part A Provider - Skilled Nursing Facility | 9931112273 | Practice locations: Birmingham, AL |
Skilled nursing facility certification: CCN 015388
- Legal name
- EAST GLEN, LLC
- Doing business as
- EAST GLEN
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 29, 1985
- Last certification
- Mar 16, 2023
- Beds
- 108
- Ownership / control type
- Corporation
- Multi-facility organization
- NOLAND HEALTH SERVICES
- Most recent change of ownership
- Jul 1, 2006
- Organization structure
- LLC
- Incorporated
- Jul 24, 2002 in DE
- Enrollment address
- 53 Medical Park E Dr
Birmingham, AL 35235-3402 - Nursing home name
- EAST GLEN
- Affiliated entity
- NOLAND HEALTH
Care Compare: Nursing home
Medicare Care Compare- Listed as
- East Glen
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Mar 29, 1985
- Medicare certification status
- Active
- Certified beds
- 108
- Chain
- Noland Health
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D0672718 | East Glen LLC | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryLocations
53 Medical Park Dr E
Birmingham, AL 35235
Phone (205) 833-1777
Ownership & related parties
All disclosed owners & managing parties 22
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Crystal a Blackwell | Operational/Managerial Control | Mar 9, 2025 | |
| Adp of the SNF | Mar 9, 2025 | ||
| Robert Gary Goff | Corporate Director | Jul 1, 2006 | |
| Managing Control - Governing Body | Jul 1, 2006 | ||
| Kelley Z Urban | Operational/Managerial Control | Mar 3, 2019 | |
| Adp of the SNF | Mar 3, 2019 | ||
| Stephanie Howard | Operational/Managerial Control | Dec 5, 2022 | |
| Adp of the SNF | Dec 5, 2022 | ||
| Michele B Adamson | Corporate Director | May 10, 2017 | |
| Managing Control - Governing Body | May 10, 2017 | ||
| Noland Health Services, Inc | 5% Or Greater Direct Ownership Interest | Jul 1, 2006 | 100% |
| Operational/Managerial Control | Jul 1, 2006 | ||
| Adp of the SNF | Jul 1, 2006 | ||
| Karen Kenwright | Operational/Managerial Control | Nov 27, 2017 | |
| Adp of the SNF | Nov 27, 2017 | ||
| Nicholas V Renda | Corporate Director | Oct 26, 2020 | |
| Operational/Managerial Control | Oct 26, 2020 | ||
| Managing Control - Governing Body | Oct 26, 2020 | ||
| Adp of the SNF | Oct 26, 2020 | ||
| Matthew Hall | Operational/Managerial Control | Jan 31, 2022 | |
| Adp of the SNF | Jan 31, 2022 | ||
| Isaac Ripon Britton | Corporate Director | Feb 14, 2007 | |
| Managing Control - Governing Body | Feb 14, 2007 | ||
| James T Waggoner | Corporate Director | May 10, 2017 | |
| Managing Control - Governing Body | May 10, 2017 | ||
| Yolonda Polk | Operational/Managerial Control | May 17, 2021 | |
| Adp of the SNF | May 17, 2021 | ||
| Kathy Smothers | Operational/Managerial Control | Apr 12, 2021 | |
| Adp of the SNF | Apr 12, 2021 | ||
| George S Smith | Corporate Director | Aug 25, 2009 | |
| Managing Control - Governing Body | Aug 25, 2009 | ||
| Debra J Nelson | Corporate Director | May 11, 2017 | |
| Managing Control - Governing Body | May 11, 2017 | ||
| Barbara E. Estep | Corporate Director | Apr 1, 2024 | |
| Operational/Managerial Control | Apr 1, 2024 | ||
| Managing Control - Governing Body | Apr 1, 2024 | ||
| Adp of the SNF | Apr 1, 2024 | ||
| Gregory M Flippo | Adp of the SNF | Jul 1, 2006 | |
| Warren Averett LLC | Adp of the SNF | Jun 1, 2022 | |
| Flippo Enterprises LLC | Adp of the SNF | Feb 1, 2018 | |
| Nutrition Plus, LLC | Adp of the SNF | Nov 15, 2023 | |
| Noland Pharmacy LLC | Adp of the SNF | Jul 1, 2023 | |
| Ascension Health Alliance | 5% Or Greater Indirect Ownership Interest | Mar 31, 2005 | |
| Adp of the SNF | Apr 11, 2025 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Facilities with the same owner 60
Facilities that share an organizational owner with 5% or greater ownership or operational control.
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- NPI 1598214272
Noland Health Services, Inc
-
- Skilled Nursing Facility
- Birmingham, AL
- NPI 1962409797
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-
- Skilled Nursing Facility
- Daphne, AL
- NPI 1497113740
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-
- Skilled Nursing Facility
- Dothan, AL
- NPI 1720837966
Noland Health Services, Inc
-
- Skilled Nursing Facility
- Fairhope, AL
- NPI 1134648405
Noland Health Services, Inc
-
- Long Term Care Hospital
- Anniston, AL
- NPI 1538166343
Noland Health Services, Inc
-
- Long Term Care Hospital
- Birmingham, AL
- NPI 1770580581
Noland Health Services, Inc
-
- Long Term Care Hospital
- Dothan, AL
- NPI 1497752281
Noland Health Services, Inc
-
- Long Term Care Hospital
- Tuscaloosa, AL
- NPI 1336146141
Noland Health Services, Inc
-
- Skilled Nursing Facility
- Mobile, AL
- NPI 1477916674
Noland Health Services, Inc
-
- Skilled Nursing Facility
- Bessemer, AL
- NPI 1811136526
Noland Health Services, Inc
-
- Skilled Nursing Facility
- Sylacauga, AL
- NPI 1013115674
Noland Health Services, Inc
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Trussville, AL
- NPI 1033187109
-
- Internal Medicine Physician
- Birmingham, AL
- NPI 1033142054
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1731369600000",
"number": "1366498941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 CORPORATE PKWY",
"address_2": "SUITE 100",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352422934",
"telephone_number": "205-783-8460",
"fax_number": "205-783-8450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "53 MEDICAL PARK DRIVE, EAST",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352353402",
"telephone_number": "205-836-4231",
"fax_number": "205-838-5327"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EAST GLEN, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "NOLAND HEALTH SERVICES, INC.",
"enumeration_date": "2006-05-26",
"last_updated": "2024-11-12",
"certification_date": "2024-11-12",
"status": "A",
"authorized_official_last_name": "RENDA",
"authorized_official_first_name": "NICHOLAS",
"authorized_official_middle_name": "V",
"authorized_official_title_or_position": "EVP/CFO",
"authorized_official_telephone_number": "205-783-8460"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "AL",
"license": "12566",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47580505",
"state": "AL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "East Glen",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.