Glenwood House Residential Care, Inc.

NPI #1205014727 in Streator, Illinois

Provider Information

NPI Number: 1205014727
Entity Type: Organization
Organization Name: Glenwood House Residential Care, Inc.
Primary Specialty: Intermediate Care Facility, Intellectual Disabilities
Enumeration Date: Feb 6, 2008
Last Updated: Feb 6, 2008

Practice Location

Address: 300 W 12TH ST
City: Streator
State: Illinois
ZIP Code: 61364-3301
Phone: (815) 673-1182

Authorized Official

Name: MR. RALPH S GOMES
Title: PRESIDENT
Phone: (815) 673-1182

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Intermediate Care Facility, Intellectual Disabilities	315P00000X	Primary

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