Provider Demographics
NPI:1063294627
Name:GLSL MANAGEMENT COMPANY
Entity type:Organization
Organization Name:GLSL MANAGEMENT COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER / OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPROULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-302-4515
Mailing Address - Street 1:5066 ARAPAHOE ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3773
Mailing Address - Country:US
Mailing Address - Phone:505-302-4515
Mailing Address - Fax:
Practice Address - Street 1:15 W 100 N
Practice Address - Street 2:
Practice Address - City:ELMO
Practice Address - State:UT
Practice Address - Zip Code:84521-3985
Practice Address - Country:US
Practice Address - Phone:435-653-2555
Practice Address - Fax:435-653-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care