Healthcare Provider Details

I. General information

NPI: 1588617393
Provider Name (Legal Business Name): LAUREL SPRINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 TWIN PONDS LN
LONDON KY
40741-9268
US

IV. Provider business mailing address

PO BOX 226
LONDON KY
40743-0226
US

V. Phone/Fax

Practice location:
  • Phone: 606-877-6445
  • Fax: 606-877-6574
Mailing address:
  • Phone: 606-877-5127
  • Fax: 606-877-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. CARLA REED
Title or Position: VICE PRESIDENT
Credential:
Phone: 606-877-6445