Basic Information
| Provider Information | |||||||||
| NPI: | 1245454677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE LAURELS OF BON AIR, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9101 BON AIR CROSSINGS DRIVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045219980 | ||||||||
| FaxNumber: | 6147948826 | ||||||||
| Practice Location | |||||||||
| Address1: | 9101 BON AIR CROSSINGS DRIVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045219980 | ||||||||
| FaxNumber: | 6147948826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | ANIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6147948800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH2761 | VA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.