Provider Demographics
NPI:1366771883
Name:GLOW HOUSE
Entity type:Organization
Organization Name:GLOW HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-342-3343
Mailing Address - Street 1:5355 TILE PLANT RD SE
Mailing Address - Street 2:PO BOX 598
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-9801
Mailing Address - Country:US
Mailing Address - Phone:740-343-0793
Mailing Address - Fax:740-343-0794
Practice Address - Street 1:5355 TILE PLANT RD SE
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9801
Practice Address - Country:US
Practice Address - Phone:740-343-0793
Practice Address - Fax:740-343-0794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT ALOYSIUS CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6410512315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2995933Medicaid