Healthcare Provider Details

I. General information

NPI: 1871980722
Provider Name (Legal Business Name): LAUREL AVENUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 LAUREL AVE
REDLANDS CA
92373-4838
US

IV. Provider business mailing address

701 PALOMAR AIRPORT RD SUITE 300
CARLSBAD CA
92011-1027
US

V. Phone/Fax

Practice location:
  • Phone: 909-792-6050
  • Fax:
Mailing address:
  • Phone: 858-200-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: JEANNE STEELE
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 909-792-6050