Provider Demographics
NPI:1992035356
Name:KIRKLAND, GLENDA R
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:R
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 KUYKENDALL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-9612
Mailing Address - Country:US
Mailing Address - Phone:828-645-7943
Mailing Address - Fax:
Practice Address - Street 1:75 KUYKENDALL BRANCH RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-9612
Practice Address - Country:US
Practice Address - Phone:828-645-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-011-290310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility