Provider Demographics
NPI:1992399786
Name:LAURENT GROUP HOME INC
Entity Type:Organization
Organization Name:LAURENT GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN LAURENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-213-7914
Mailing Address - Street 1:261 SW FAIRCHILD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4908
Mailing Address - Country:US
Mailing Address - Phone:954-213-7914
Mailing Address - Fax:
Practice Address - Street 1:261 SW FAIRCHILD AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4908
Practice Address - Country:US
Practice Address - Phone:954-213-7914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities