=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528175353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAUREL HOMECARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 62 S LAUREL ST
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-1945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-451-1711
-----------------------------------------------------
Fax | 856-451-1409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 62 S LAUREL ST
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-1945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-451-1711
-----------------------------------------------------
Fax | 856-451-1409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | MR. JAMES RODGERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-451-1711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------