Provider Demographics
NPI:1437239167
Name:THE LAURELS OF GREENTREE RIDGE, INC.
Entity Type:Organization
Organization Name:THE LAURELS OF GREENTREE RIDGE, INC.
Other - Org Name:THE LAURELS OF GREENTREE RIDGE
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 1:70 SWEETEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2318
Mailing Address - Country:US
Mailing Address - Phone:828-274-7646
Mailing Address - Fax:828-277-4752
Practice Address - Street 1:70 SWEETEN CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2318
Practice Address - Country:US
Practice Address - Phone:828-274-7646
Practice Address - Fax:828-277-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH 0463332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC923203OtherFACILITY ID#
NC0097YOtherBC/BS #
NC7171166OtherUNITED HEALTH CARE ID #
NCNH0463OtherNH LICENSE #
NC3415303Medicaid
NC3415303Medicaid