Healthcare Provider Details

I. General information

NPI: 1851836118
Provider Name (Legal Business Name): THE LAURELS OF PENDER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S CAMPBELL ST
BURGAW NC
28425-5011
US

IV. Provider business mailing address

8181 WORTHINGTON RD
WESTERVILLE OH
43082-8067
US

V. Phone/Fax

Practice location:
  • Phone: 910-259-6007
  • Fax: 910-259-6007
Mailing address:
  • Phone: 614-794-8800
  • Fax: 614-794-8726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ANIS KHAN
Title or Position: CFO
Credential:
Phone: 614-794-8800