1346330313 NPI number — LAUREL HEALTH CARE COMPANY OF PERRINTON

Table of content: (NPI 1346330313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346330313 NPI number — LAUREL HEALTH CARE COMPANY OF PERRINTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAUREL HEALTH CARE COMPANY OF PERRINTON
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:
Provider Other Organization Name Type Code:
6
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:
1346330313
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:
4735 RANGER RD
Provider Second Line Business Mailing Address:
RFD #1
Provider Business Mailing Address City Name:
PERRINTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-236-5433
Provider Business Mailing Address Fax Number:
989-236-7672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4735 RANGER RD
Provider Second Line Business Practice Location Address:
RFD #1
Provider Business Practice Location Address City Name:
PERRINTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-236-5433
Provider Business Practice Location Address Fax Number:
989-236-7672
Provider Enumeration Date:
10/13/2006

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:  294010 , 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: 294010 . This is a "NH LICENSE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3202046 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7105581 . 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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