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General NPI Number Information
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NPI Number | 1871980722
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Entity Type | Organization
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Legal Business Name | LAUREL AVENUE LLC
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 1618 LAUREL AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4838
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Country | US
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Telephone | 909-792-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 701 PALOMAR AIRPORT RD SUITE 300
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City | CARLSBAD
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State | CA
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Zip | 92011-1027
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Country | US
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Telephone | 858-200-6145
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | JEANNE STEELE
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Credential |
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Telephone | 909-792-6050
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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 |
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License Number State | CA
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