Healthcare Provider Details

I. General information

NPI: 1407351067
Provider Name (Legal Business Name): THE LAURELS OF MIDDLETOWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 KENSINGTON ST
MIDDLETOWN OH
45044
US

IV. Provider business mailing address

8181 WORTHINGTON RD
WESTERVILLE OH
43082-8067
US

V. Phone/Fax

Practice location:
  • Phone: 513-424-3511
  • Fax: 513-424-3695
Mailing address:
  • Phone: 614-794-8800
  • Fax:

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: MR. ANIS KHAN
Title or Position: C.F.O.
Credential:
Phone: 614-794-8800