Provider Demographics
NPI:1457459430
Name:LAUREL HEALTH CARE COMPANY OF NORTH CAROLINA, INC.
Entity Type:Organization
Organization Name:LAUREL HEALTH CARE COMPANY OF NORTH CAROLINA, INC.
Other - Org Name:THE LAURELS OF HENDERSONVILLE
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 1:290 CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-6148
Mailing Address - Country:US
Mailing Address - Phone:828-692-6000
Mailing Address - Fax:828-692-6804
Practice Address - Street 1:290 CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-6148
Practice Address - Country:US
Practice Address - Phone:828-692-6000
Practice Address - Fax:828-692-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0480332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNH0480OtherFACILITY LICENSE #
NC923081OtherFACILITY ID #
NC3415322Medicaid
NC0097XOtherBLUE CROSS BLUE SHIELD
NC923081OtherFACILITY ID #