Healthcare Provider Details

I. General information

NPI: 1265755755
Provider Name (Legal Business Name): THE LAURELS OF CANTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 13TH ST NW
CANTON OH
44708-3121
US

IV. Provider business mailing address

2714 13TH ST NW
CANTON OH
44708-3121
US

V. Phone/Fax

Practice location:
  • Phone: 614-794-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1539N
License Number StateOH

VIII. Authorized Official

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