Provider Demographics
NPI:1144521493
Name:LAUREL MANOR GROUP HOMES, INC.
Entity type:Organization
Organization Name:LAUREL MANOR GROUP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:843-462-2387
Mailing Address - Street 1:134 W MAIN ST
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:HARLEYVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29448-3700
Mailing Address - Country:US
Mailing Address - Phone:843-462-2387
Mailing Address - Fax:
Practice Address - Street 1:134 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYVILLE
Practice Address - State:SC
Practice Address - Zip Code:29448-3700
Practice Address - Country:US
Practice Address - Phone:843-462-2387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health