Provider Demographics
NPI:1619087525
Name:LAUREL LAKE HEALTH AND REHABILITATION, L.L.C.
Entity Type:Organization
Organization Name:LAUREL LAKE HEALTH AND REHABILITATION, L.L.C.
Other - Org Name:KINDRED NURSING AND REHABILITATION-LAUREL LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7563
Mailing Address - Street 1:680 S 4TH ST # KH-2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 LAUREL ST
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-9181
Practice Address - Country:US
Practice Address - Phone:413-243-2010
Practice Address - Fax:413-243-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0008314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1005195OtherAETNA
MA225749OtherCCS
MA000000026404OtherBMC HEALTH NET
MA0921271Medicaid
MA00925381OtherMARTINS POINT
MA1005195OtherSENIOR WHOLE HEALTH
MA2222574901OtherBLUE CROSS BLUE SHIELD
225749Medicare Oscar/Certification