Provider Demographics
NPI:1811549579
Name:LAUREATE TERRACE OPERATIONS LLC
Entity Type:Organization
Organization Name:LAUREATE TERRACE OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-426-8849
Mailing Address - Street 1:13024 BALNTYN CORP PL STE 425
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4420
Mailing Address - Country:US
Mailing Address - Phone:704-426-8849
Mailing Address - Fax:
Practice Address - Street 1:1615 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-3810
Practice Address - Country:US
Practice Address - Phone:847-244-6700
Practice Address - Fax:847-244-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility