Organization Active NPI

East Glen, LLC

  • Skilled Nursing Facility
  • Birmingham, AL
National Provider Identifier
1366498941
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
12566 Issued in AL
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.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
47580505MedicaidAL

Other names 1

  • East Glen Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
LLCNon-profit
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 GlenCCN 015388
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 29, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10897.0 residents per day on average
Chain
Noland Health10 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0672718East Glen LLC53 Medical Park Drive East, Birmingham, AL 35235Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

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.

NameRoleSinceShare
Crystal a Blackwell Individual Operational/Managerial Control Mar 9, 2025
Adp of the SNF Mar 9, 2025
Robert Gary Goff Individual Corporate DirectorBoard Member Jul 1, 2006
Managing Control - Governing BodyBoard Member Jul 1, 2006
Kelley Z Urban Individual Operational/Managerial Control Mar 3, 2019
Adp of the SNF Mar 3, 2019
Stephanie Howard Individual Operational/Managerial Control Dec 5, 2022
Adp of the SNF Dec 5, 2022
Michele B Adamson Individual Corporate DirectorBoard Member May 10, 2017
Managing Control - Governing BodyBoard Member May 10, 2017
Noland Health Services, Inc Organization, Birmingham, AL Corporation, Chain home office 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 Individual Operational/Managerial Control Nov 27, 2017
Adp of the SNF Nov 27, 2017
Nicholas V Renda Individual Corporate DirectorEvp/Cfo/Board Member Oct 26, 2020
Operational/Managerial Control Oct 26, 2020
Managing Control - Governing BodyEvp/Cfo/Board Member Oct 26, 2020
Adp of the SNF Oct 26, 2020
Matthew Hall Individual Operational/Managerial Control Jan 31, 2022
Adp of the SNF Jan 31, 2022
Isaac Ripon Britton Individual Corporate DirectorBoard Member Feb 14, 2007
Managing Control - Governing BodyBoard Member Feb 14, 2007
James T Waggoner Individual Corporate DirectorBoard Member May 10, 2017
Managing Control - Governing BodyBoard Member May 10, 2017
Yolonda Polk Individual Operational/Managerial Control May 17, 2021
Adp of the SNF May 17, 2021
Kathy Smothers Individual Operational/Managerial Control Apr 12, 2021
Adp of the SNF Apr 12, 2021
George S Smith Individual Corporate DirectorBoard Member Aug 25, 2009
Managing Control - Governing BodyBoard Member Aug 25, 2009
Debra J Nelson Individual Corporate DirectorBoard Member May 11, 2017
Managing Control - Governing BodyBoard Member May 11, 2017
Barbara E. Estep Individual Corporate DirectorPresident/Ceo/Board Member Apr 1, 2024
Operational/Managerial Control Apr 1, 2024
Managing Control - Governing BodyPresident/Ceo/Board Member Apr 1, 2024
Adp of the SNF Apr 1, 2024
Gregory M Flippo Individual Adp of the SNF Jul 1, 2006
Warren Averett LLC Organization, Birmingham, AL LLC, Consulting firm Adp of the SNF Jun 1, 2022
Flippo Enterprises LLC Organization, Pinson, AL LLC, Medical provider/supplier Adp of the SNF Feb 1, 2018
Nutrition Plus, LLC Organization, Hoover, AL LLC Adp of the SNF Nov 15, 2023
Noland Pharmacy LLC Organization, Daphne, AL LLC, Medical provider/supplier Adp of the SNF Jul 1, 2023
Ascension Health Alliance Organization, Saint Louis, MO Corporation 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.

View all 60

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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

Verify at the official NPI Registry.