Healthcare Provider Details

I. General information

NPI: 1346776085
Provider Name (Legal Business Name): LAURIN MANOR ASSISTED LIVING FACILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 SAINT JOHN AVE S
BOYNTON BEACH FL
33472-1112
US

IV. Provider business mailing address

125 S STATE ROAD 7 STE 104-198
WELLINGTON FL
33414-4385
US

V. Phone/Fax

Practice location:
  • Phone: 561-509-6841
  • Fax: 561-877-8707
Mailing address:
  • Phone: 954-560-8917
  • Fax: 561-877-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: LYSE LAURIN-PIERRE
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-560-8917