Healthcare Provider Details

I. General information

NPI: 1447335179
Provider Name (Legal Business Name): THE LAURELS OF CHARLOTTESVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 PEPSI PL
CHARLOTTESVILLE VA
22901-2866
US

IV. Provider business mailing address

1165 PEPSI PL
CHARLOTTESVILLE VA
22901-2866
US

V. Phone/Fax

Practice location:
  • Phone: 434-951-4200
  • Fax: 434-951-4201
Mailing address:
  • Phone: 434-951-4200
  • Fax: 434-951-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberNH2754
License Number StateVA

VIII. Authorized Official

Name: MR. TIMOTHY PATTON
Title or Position: CFO
Credential:
Phone: 614-794-8800