Healthcare Provider Details

I. General information

NPI: 1245454677
Provider Name (Legal Business Name): THE LAURELS OF BON AIR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 BON AIR CROSSINGS DRIVE
RICHMOND VA
23235
US

IV. Provider business mailing address

9101 BON AIR CROSSINGS DRIVE
RICHMOND VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 804-521-9980
  • Fax: 614-794-8826
Mailing address:
  • Phone: 804-521-9980
  • Fax: 614-794-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2761
License Number StateVA

VIII. Authorized Official

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