Healthcare Provider Details

I. General information

NPI: 1053756734
Provider Name (Legal Business Name): THE LAURELS OF NEW LONDON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W MAIN ST
NEW LONDON OH
44851-1070
US

IV. Provider business mailing address

204 W MAIN ST
NEW LONDON OH
44851-1070
US

V. Phone/Fax

Practice location:
  • Phone: 419-929-1563
  • Fax:
Mailing address:
  • Phone: 419-929-1563
  • 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: CFO
Credential:
Phone: 614-794-8800