Healthcare Provider Details

I. General information

NPI: 1316120306
Provider Name (Legal Business Name): LAUREL HOUSING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W 12TH ST
LONDON KY
40741-1101
US

IV. Provider business mailing address

PO BOX 1800
LONDON KY
40743-1800
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-4155
  • Fax:
Mailing address:
  • Phone: 606-864-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number100280
License Number StateKY

VIII. Authorized Official

Name: MRS. KATHEY YOUNG
Title or Position: ADMINISTRATOR
Credential:
Phone: 606-864-4155