Provider Demographics
NPI:1346330313
Name:LAUREL HEALTH CARE COMPANY OF PERRINTON
Entity Type:Organization
Organization Name:LAUREL HEALTH CARE COMPANY OF PERRINTON
Other - Org Name:THE LAURELS OF FULTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-794-8800
Mailing Address - Street 1:4735 RANGER RD
Mailing Address - Street 2:RFD #1
Mailing Address - City:PERRINTON
Mailing Address - State:MI
Mailing Address - Zip Code:48871
Mailing Address - Country:US
Mailing Address - Phone:989-236-5433
Mailing Address - Fax:989-236-7672
Practice Address - Street 1:4735 RANGER RD
Practice Address - Street 2:RFD #1
Practice Address - City:PERRINTON
Practice Address - State:MI
Practice Address - Zip Code:48871
Practice Address - Country:US
Practice Address - Phone:989-236-5433
Practice Address - Fax:989-236-7672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI294010332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI294010OtherNH LICENSE #
MI3202046Medicaid
MI7105581OtherUNITED HEALTH CARE ID #
MI7105581OtherUNITED HEALTH CARE ID #