Provider Demographics
NPI:1164418471
Name:LAUREL WOODS HEALTH CARE CENTER LLC
Entity Type:Organization
Organization Name:LAUREL WOODS HEALTH CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, APPLE HEALTH CARE INC
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-678-9755
Mailing Address - Street 1:451 N. HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-1555
Mailing Address - Country:US
Mailing Address - Phone:203-466-6850
Mailing Address - Fax:203-466-6852
Practice Address - Street 1:451 N. HIGH STREET
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-1555
Practice Address - Country:US
Practice Address - Phone:203-466-6850
Practice Address - Fax:203-466-6852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLE HEALTH CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-22
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2121-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000021212Medicaid
CT000021212Medicaid
CT075389Medicare Oscar/Certification