Provider Demographics
NPI:1033110341
Name:LAUREL HOUSING INC
Entity Type:Organization
Organization Name:LAUREL HOUSING INC
Other - Org Name:LAUREL HEIGHTS HOME FOR THE ELDERLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-864-4155
Mailing Address - Street 1:PO BOX 1800
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-1800
Mailing Address - Country:US
Mailing Address - Phone:606-864-4155
Mailing Address - Fax:606-878-6780
Practice Address - Street 1:208 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1101
Practice Address - Country:US
Practice Address - Phone:606-864-4155
Practice Address - Fax:606-878-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100280314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY36130900OtherBLACK LUNG
KY12500815Medicaid
KY36130900OtherBLACK LUNG
KY185003Medicare Oscar/Certification