Healthcare Provider Details

I. General information

NPI: 1114972734
Provider Name (Legal Business Name): LAUREL HEALTH CARE COMPANY OF GALESBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 N 35TH ST
GALESBURG MI
49053-9727
US

IV. Provider business mailing address

4000 TOWN CTR STE 2000
SOUTHFIELD MI
48075-1415
US

V. Phone/Fax

Practice location:
  • Phone: 616-665-7043
  • Fax: 616-665-4080
Mailing address:
  • Phone: 248-386-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number394150
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number394150
License Number StateMI

VIII. Authorized Official

Name: ANIS KHAN
Title or Position: CFO
Credential:
Phone: 248-386-0300