Provider Demographics
NPI:1114088572
Name:LAURENT HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:LAURENT HOME HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROTIMI
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-999-8821
Mailing Address - Street 1:1201 N WATSON RD
Mailing Address - Street 2:SUITE 292
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006
Mailing Address - Country:US
Mailing Address - Phone:817-633-0310
Mailing Address - Fax:
Practice Address - Street 1:1201 N WATSON RD
Practice Address - Street 2:SUITE 292
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6190
Practice Address - Country:US
Practice Address - Phone:817-633-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011524OtherLICENSE NUMBER
TX011524OtherLICENSE NUMBER