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General NPI Number Information
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NPI Number | 1265755755
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Entity Type | Organization
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Legal Business Name | THE LAURELS OF CANTON, LLC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 2714 13TH ST NW
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City | CANTON
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State | OH
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Zip | 44708-3121
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Country | US
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Telephone | 614-794-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 2714 13TH ST NW
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City | CANTON
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State | OH
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Zip | 44708-3121
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ANIS KHAN
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Credential |
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Telephone | 614-794-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1539N
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License Number State | OH
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