MEDICARE: LAURELWOOD GROUP HOME, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1669215539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURELWOOD GROUP HOME, LLC

Provider Business Mailing Address
First Line	:	4752 TORRENCE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4336
Country	:	US
Telephone Number	:	702-580-5123
Fax Number	:

Provider Business Practice Location Address
First Line	:	4752 TORRENCE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4336
Country	:	US
Telephone Number	:	702-580-5123
Fax Number	:	702-570-5785

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	GORAN BEKIROV
Credential	:
Telephone Number	:	702-580-5123

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/17/2024

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