Provider Demographics
NPI:1205027588
Name:LP ELKTON LLC
Entity Type:Organization
Organization Name:LP ELKTON LLC
Other - Org Name:LAURELWOOD CARE CENTER AT ELKTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7800
Mailing Address - Fax:502-568-7150
Practice Address - Street 1:100 LAUREL DR
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5328
Practice Address - Country:US
Practice Address - Phone:410-398-8800
Practice Address - Fax:410-398-4952
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP CS HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07-003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215111Medicare Oscar/Certification
6297110001Medicare NSC