Healthcare Provider Details

I. General information

NPI: 1184848293
Provider Name (Legal Business Name): LAURELS OF JEFFERSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 STANTON BLVD
STEUBENVILLE OH
43952-3706
US

IV. Provider business mailing address

500 STANTON BLVD
STEUBENVILLE OH
43952-3706
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-5042
  • Fax: 614-794-8826
Mailing address:
  • Phone: 740-264-5042
  • Fax: 614-794-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2497N
License Number StateOH

VIII. Authorized Official

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