Provider Demographics
NPI:1588662936
Name:LAUREL WOOD CARE CENTER, LLC
Entity Type:Organization
Organization Name:LAUREL WOOD CARE CENTER, LLC
Other - Org Name:LAUREL WOOD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-963-9150
Mailing Address - Street 1:209 SIGMA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2826
Mailing Address - Country:US
Mailing Address - Phone:412-963-9150
Mailing Address - Fax:412-963-6676
Practice Address - Street 1:100 WOODMONT RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1342
Practice Address - Country:US
Practice Address - Phone:814-255-1488
Practice Address - Fax:814-255-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA380502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0548OtherSECURITY BLUE
PA1399778OtherUMWA PROVIDER NUMBER
071007900OtherFEDERAL BLACK LUNG PROGRA
PA000000114520OtherUNISON (MED PLUS/3 RIVERS
PA1007294850003Medicaid
PA0548OtherBLUE CROSS PROVIDER NO.
PA1007294850003Medicaid
PA=========OtherHEALTH AMERICA
PA1007294850003Medicaid