Provider Demographics
NPI:1992794788
Name:NEW GLASGOW HEALTH & REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:NEW GLASGOW HEALTH & REHABILITATION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:GUMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-651-6661
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-0938
Mailing Address - Country:US
Mailing Address - Phone:270-651-6661
Mailing Address - Fax:270-651-7881
Practice Address - Street 1:220 WESTWOOD ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1028
Practice Address - Country:US
Practice Address - Phone:270-651-6661
Practice Address - Fax:270-651-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100014314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18-5340Medicare ID - Type Unspecified