MEDICARE: LAURIN MANOR ASSISTED LIVING FACILITY, LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1346776085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURIN MANOR ASSISTED LIVING FACILITY, LLC

Provider Business Mailing Address
First Line	:	125 S STATE ROAD 7 STE 104-198
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4385
Country	:	US
Telephone Number	:	954-560-8917
Fax Number	:	561-877-8707

Provider Business Practice Location Address
First Line	:	5170 SAINT JOHN AVE S
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-1112
Country	:	US
Telephone Number	:	561-509-6841
Fax Number	:	561-877-8707

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LYSE LAURIN-PIERRE
Credential	:
Telephone Number	:	954-560-8917

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	05/01/2017

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