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General NPI Number Information
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NPI Number | 1669534566
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Entity Type | Organization
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Legal Business Name | LAURELBROOK SANITARIUM AND SCHOOL
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 200 SANITARIUM CIRCLE
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City | DAYTON
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State | TN
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Zip | 37321-4635
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Country | US
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Telephone | 423-775-0771
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Fax | 423-834-9059
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Provider Business Mailing Address
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Address Line | 114 CAMPUS DRIVE
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City | DAYTON
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State | TN
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Zip | 37321-4635
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Country | US
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Telephone | 423-775-0771
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Fax | 423-775-6346
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEITH WELLMAN
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Credential |
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Telephone | 423-775-0771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 00000000208
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License Number State | TN
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