MEDICARE: LAUREL HEALTHCARE 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	314000000X	Skilled Nursing Facility	060405	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730466392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	24 WEST PKWY
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014-1228
Country	:	US
Telephone Number	:	917-379-8074
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 W LAUREL RD
Second Line	:
City	:	STRATFORD
State	:	NJ
Zip	:	08084-1718
Country	:	US
Telephone Number	:	856-784-2400
Fax Number	:

Authorized Official
Title or Position	:	LLC MEMBER
Name	:	MR. MOSHE BRODT
Credential	:
Telephone Number	:	917-379-8074

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	01/19/2012

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Directions to “LAUREL HEALTHCARE LLC ” Practice Location

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