Organization
GLEN PARK EAST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TILLMAN PINK JR. (PRESIDENT)
(818) 242-9000
Entity
Organization
Contact information
Practice address
1250 BOYNTON ST, GLENDALE, CA 91205-3451
(818) 246-9000
(818) 246-1577
Mailing address
1220 MARIPOSA ST, GLENDALE, CA 91205-3254
(818) 242-9000
(818) 242-3972
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
191221691
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RCF00031F
—
CA
Enumeration date
08/07/2008
Last updated
08/07/2008
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