Basic Information
| Provider Information | |||||||||
| NPI: | 1285874560 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAUREL WELLNESS AND NURSING CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4032 WILSHIRE BLVD STE 600 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900103405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133896900 | ||||||||
| FaxNumber: | 2133688560 | ||||||||
| Practice Location | |||||||||
| Address1: | 7509 LAUREL AVE | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923362315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098228066 | ||||||||
| FaxNumber: | 2133688560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 02/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | LEHMANN | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 2133896900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.