Healthcare Provider Details
I. General information
NPI: 1093304677
Provider Name (Legal Business Name): LAURELS NC OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/18/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
200 RICEVILLE RD
ASHEVILLE NC
28805-6101
US
IV. Provider business mailing address
980 SYLVAN AVE
ENGLEWOOD CLIFFS NJ
07632-3301
US
V. Phone/Fax
- Phone: 828-299-1110
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 314000000X |
| Taxonomy | Skilled Nursing Facility |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 385H00000X |
| Taxonomy | Respite Care |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
DEVORA
KIRSCHNER
Title or Position: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 828-299-1110