Provider Demographics
NPI:1063409647
Name:GLENWOOD VILLAGE CARE CENTER INC
Entity type:Organization
Organization Name:GLENWOOD VILLAGE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUGISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-763-1164
Mailing Address - Street 1:719 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1810
Mailing Address - Country:US
Mailing Address - Phone:320-634-5131
Mailing Address - Fax:320-634-5777
Practice Address - Street 1:719 2ND ST SE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1810
Practice Address - Country:US
Practice Address - Phone:320-634-5131
Practice Address - Fax:320-634-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0309130901OtherPRIMEWEST
MN9622GLOtherBLUE CROSS OF MN
MN030913090OtherPRIMEWEST
MN71-22756OtherMEDICA
MN938342500Medicaid
MN938342500Medicaid