Provider Demographics
NPI:1871683011
Name:LAUREL HEALTH CARE COMPANY OF LOWELL
Entity Type:Organization
Organization Name:LAUREL HEALTH CARE COMPANY OF LOWELL
Other - Org Name:THE LAURELS OF KENT
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 1:350 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-1212
Mailing Address - Country:US
Mailing Address - Phone:616-897-8473
Mailing Address - Fax:616-897-0081
Practice Address - Street 1:350 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-1212
Practice Address - Country:US
Practice Address - Phone:616-897-8473
Practice Address - Fax:616-897-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI414340332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI414340OtherNH LICENSE #
MI7105585OtherUNITED HEALTH CARE ID #
MI3202073Medicaid
MI7105585OtherUNITED HEALTH CARE ID #