Healthcare Provider Details

I. General information

NPI: 1346330313
Provider Name (Legal Business Name): LAUREL HEALTH CARE COMPANY OF PERRINTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 RANGER RD RFD #1
PERRINTON MI
48871
US

IV. Provider business mailing address

4735 RANGER RD RFD #1
PERRINTON MI
48871
US

V. Phone/Fax

Practice location:
  • Phone: 989-236-5433
  • Fax: 989-236-7672
Mailing address:
  • Phone: 989-236-5433
  • Fax: 989-236-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number294010
License Number StateMI

VIII. Authorized Official

Name: MR. TIMOTHY PATTON
Title or Position: CFO
Credential:
Phone: 614-794-8800