Provider Demographics
NPI:1851836118
Name:THE LAURELS OF PENDER, LLC
Entity Type:Organization
Organization Name:THE LAURELS OF PENDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-794-8800
Mailing Address - Street 1:8181 WORTHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8067
Mailing Address - Country:US
Mailing Address - Phone:614-794-8800
Mailing Address - Fax:614-794-8726
Practice Address - Street 1:311 S CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5011
Practice Address - Country:US
Practice Address - Phone:910-259-6007
Practice Address - Fax:910-259-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1851836118Medicaid
NC345298Medicare Oscar/Certification