Basic Information
| Provider Information | |||||||||
| NPI: | 1669570925 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAUREL HEALTH CARE COMPANY OF HILLSBORO | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE LAURELS OF HILLSBORO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 CHILLICOTHE AVE | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451331533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373931925 | ||||||||
| FaxNumber: | 9373933666 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 CHILLICOTHE AVE | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451331533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373931925 | ||||||||
| FaxNumber: | 9373933666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | PATTON | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6147948800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | 5786 | OH | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition |
ID Information
| ID | Type | State | Issuer | Description | 2153801 | 05 | OH | MEDICAID | 5786 | 01 | OH | NURSING HOME LICENSE # | OTHER | 1626-NH | 01 | OH | NH ID # | OTHER |