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General NPI Number Information
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NPI Number | 1104569656
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Entity Type | Organization
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Legal Business Name | LAURENS HAVEN
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 610 TOWNE HOUSE LN
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City | RICHARDSON
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State | TX
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Zip | 75081-3530
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Country | US
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Telephone | 504-333-9969
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Fax | 469-248-0051
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Provider Business Mailing Address
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Address Line | PO BOX 852513
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City | RICHARDSON
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State | TX
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Zip | 75085-2513
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Country | US
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Telephone | 504-333-9969
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Fax | 469-248-0051
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Authorized Official
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Title or Position | LVN/CEO
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Name | MS. CATINA MARIA SAULSBERRY
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Credential | LVN
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Telephone | 504-333-9969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number |
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License Number State |
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