MEDICARE: LAUREL HILL ENTERPRISES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	4112850	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174514046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL HILL ENTERPRISES

Provider Business Mailing Address
First Line	:	420 SE MYRA RD
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1796
Country	:	US
Telephone Number	:	509-529-4480
Fax Number	:	509-529-8776

Provider Business Practice Location Address
First Line	:	420 SE MYRA RD
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1796
Country	:	US
Telephone Number	:	509-529-4480
Fax Number	:	509-529-8776

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LARRY M WHITE
Credential	:
Telephone Number	:	509-529-4480

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	08/22/2020

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Directions to “LAUREL HILL ENTERPRISES ” Practice Location

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