Provider Demographics
NPI:1285689562
Name:LAUREL HEALTH CARE COMPANY OF NORTH WORTHINGTON
Entity Type:Organization
Organization Name:LAUREL HEALTH CARE COMPANY OF NORTH WORTHINGTON
Other - Org Name:THE LAURELS OF NORWORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-794-8800
Mailing Address - Street 1:8181 WORTHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8067
Mailing Address - Country:US
Mailing Address - Phone:614-794-8800
Mailing Address - Fax:614-794-8826
Practice Address - Street 1:6830 N HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2510
Practice Address - Country:US
Practice Address - Phone:614-885-0408
Practice Address - Fax:314-885-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1388N313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2112798Medicaid
OH365222Medicare ID - Type UnspecifiedMEDICARE PROVIDER #