Provider Demographics
NPI:1528091360
Name:GLEC PLLC
Entity type:Organization
Organization Name:GLEC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DEVELOPMENT OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CORDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-953-9365
Mailing Address - Street 1:3903 HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9149
Mailing Address - Country:US
Mailing Address - Phone:269-408-1100
Mailing Address - Fax:269-408-1329
Practice Address - Street 1:3903 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9149
Practice Address - Country:US
Practice Address - Phone:269-408-1100
Practice Address - Fax:269-408-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical