Provider Demographics
NPI:1184848293
Name:LAURELS OF JEFFERSON, LLC
Entity Type:Organization
Organization Name:LAURELS OF JEFFERSON, LLC
Other - Org Name:THE LAURELS OF STEUBENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-794-8800
Mailing Address - Street 1:500 STANTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-3706
Mailing Address - Country:US
Mailing Address - Phone:740-264-5042
Mailing Address - Fax:614-794-8826
Practice Address - Street 1:500 STANTON BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3706
Practice Address - Country:US
Practice Address - Phone:740-264-5042
Practice Address - Fax:614-794-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2497N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2900918Medicaid
OH366363Medicare Oscar/Certification