| Glenwood Center Ltd | |
|
2823 Glenwood Ave Rockford IL 61101-3542 | |
| (815) 968-5342 | |
| (815) 968-4656 |
| Full Name | Glenwood Center Ltd |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2823 Glenwood Ave, Rockford, Illinois |
| Authorized Official Name and Position | Frank Eugene Cushing (PRESIDENT) |
| Authorized Official Contact | 8159685342 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenwood Center Ltd 2823 Glenwood Ave Rockford IL 61101-3542 Ph: (815) 968-5342 | Glenwood Center Ltd 2823 Glenwood Ave Rockford IL 61101-3542 Ph: (815) 968-5342 |
| NPI Number | 1003033861 |
|---|---|
| Provider Enumeration Date | 04/20/2007 |
| Last Update Date | 01/03/2008 |
| Medicare PECOS PAC ID | 2567552441 |
|---|---|
| Medicare Enrollment ID | O20071214000734 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003033861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Courtney Forman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376099127 PECOS PAC ID: 0042507220 Enrollment ID: I20161003001862 |
| Provider Name | Tracy Shadley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699263731 PECOS PAC ID: 5991051658 Enrollment ID: I20180711000089 |
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