1750465480 NPI number — LAUREL HEALTH CARE COMPANY OF BATTLE CREEK

Table of content: (NPI 1750465480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750465480 NPI number — LAUREL HEALTH CARE COMPANY OF BATTLE CREEK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAUREL HEALTH CARE COMPANY OF BATTLE CREEK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE LAURELS OF BEDFORD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750465480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 BEDFORD RD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49017-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-968-2296
Provider Business Mailing Address Fax Number:
616-968-8943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 BEDFORD RD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49017-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-968-2296
Provider Business Practice Location Address Fax Number:
616-968-8943
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATTON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
614-794-8800

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  134150 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 134150 . This is a "NH LICENSE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3198257 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09668 . This is a "BC/BS #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7105579 . This is a "UNITED HEALTH CARE ID#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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