Glen Park at Long Beach

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

198602134 Issued in CA

Legal business name

GLEN PARK AT LONG BEACH

Practice address

1046 E 4TH St
Long Beach, CA 90802-1634

Phone

(562) 432-7468

Fax

(562) 432-1425

NPI assigned

Jul 24, 2015

Organization subpart

No

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

Authorized official

Name

Tillman Pink Jr.

Title

President

Phone

(818) 242-9000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437696000000",
    "number": "1932584505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 MARIPOSA ST",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912053254",
            "telephone_number": "818-242-9000",
            "fax_number": "818-242-3972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1046 E 4TH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908021634",
            "telephone_number": "562-432-7468",
            "fax_number": "562-432-1425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN PARK AT LONG BEACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-24",
        "last_updated": "2015-07-24",
        "status": "A",
        "authorized_official_last_name": "PINK",
        "authorized_official_first_name": "TILLMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-242-9000",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "198602134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Gladney
• Gary L. Glasband, D.D.S.
• Glass House Optometry Inc (Belmont Heights Optometry)
• Edward Glassberg, M.D.
• Glbesc, LLC (MemorialCare Outpatient Surgical Center Long Beach)
• Gloria Susan Glenewinkel
• Glenn Mowbray, Psy.D.
• Charles Edward Glenn, M.A., M.F.T.
• Reid Matthew Gliddon, RPH
• Michael Glidewell, MD, MPH

• Assisted Living Facility in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; 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.