Provider Demographics
NPI:1235277690
Name:LAUREN'S HOUSE, LLC
Entity Type:Organization
Organization Name:LAUREN'S HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-490-2100
Mailing Address - Street 1:17 CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3148
Mailing Address - Country:US
Mailing Address - Phone:888-340-9420
Mailing Address - Fax:888-225-0529
Practice Address - Street 1:17 CREEK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061-3148
Practice Address - Country:US
Practice Address - Phone:888-340-9420
Practice Address - Fax:888-225-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15354001261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01854064Medicaid