Provider Demographics
NPI:1275670366
Name:LAURIE KNOLLS
Entity Type:Organization
Organization Name:LAURIE KNOLLS
Other - Org Name:LAURIE CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRI
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-374-8263
Mailing Address - Street 1:610 HWY O
Mailing Address - Street 2:
Mailing Address - City:LAURIE
Mailing Address - State:MO
Mailing Address - Zip Code:65038
Mailing Address - Country:US
Mailing Address - Phone:573-374-8263
Mailing Address - Fax:573-374-0603
Practice Address - Street 1:610 HWY O
Practice Address - Street 2:
Practice Address - City:LAURIE
Practice Address - State:MO
Practice Address - Zip Code:65038
Practice Address - Country:US
Practice Address - Phone:573-374-8263
Practice Address - Fax:573-374-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032353310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility