Active NPI
Glenwood Estate, Inc.
- Skilled Nursing Facility
- Independence, KS
National Provider Identifier
1932157708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- N063017
- Legal business name
- GLENWOOD ESTATE, INC.
- Practice address
- 1000 Mulberry St
Independence, KS 67301-2026 - Phone
- (620) 331-8789
- Fax
- (620) 331-6895
- NPI assigned
- May 4, 2006
- Organization subpart
- Yes
- Parent organization
- GLENWOOD ESTATE, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mary Ann Pollock
- Title
- Owner
- Phone
- (620) 331-8789
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | N063017 | KS | |
| Skilled Nursing Facility | 314000000X | N063017 | KS | Primary |
Addresses
Primary practice location
1000 Mulberry St
Independence, KS 67301-2026
Mailing address
1000 Mulberry St
P.O. Box 627
Independence, KS 67301-2026
Phone (620) 331-8789
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 800 | Other | KS | BLUE CROSS BLUE SHIELD |
| 100108260A | Medicaid | KS |
Other names 1
- Regal Estate of Glenwood
National Provider Directory
National Provider Directory- Part of
- Glenwood Estate
Locations
1000 Mulberry St
#627
Independence, KS 67301
Phone (620) 331-8789
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1240790400000",
"number": "1932157708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 MULBERRY ST",
"address_2": "P.O. BOX 627",
"city": "INDEPENDENCE",
"state": "KS",
"postal_code": "673012026",
"telephone_number": "620-331-8789",
"fax_number": "620-331-6895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 MULBERRY ST",
"city": "INDEPENDENCE",
"state": "KS",
"postal_code": "673012026",
"telephone_number": "620-331-8789",
"fax_number": "620-331-6895"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GLENWOOD ESTATE, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GLENWOOD ESTATE, INC.",
"enumeration_date": "2006-05-04",
"last_updated": "2009-04-27",
"status": "A",
"authorized_official_last_name": "POLLOCK",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "620-331-8789"
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "KS",
"license": "N063017",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "KS",
"license": "N063017",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "800",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100108260A",
"state": "KS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Regal Estate of Glenwood",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Independence, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.