Provider Demographics
NPI:1013310507
Name:LAURENS ESTATES, LLC
Entity type:Organization
Organization Name:LAURENS ESTATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-818-6955
Mailing Address - Street 1:1736 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-9458
Mailing Address - Country:US
Mailing Address - Phone:803-818-6955
Mailing Address - Fax:803-818-6993
Practice Address - Street 1:2841 BYPASS 127
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-8332
Practice Address - Country:US
Practice Address - Phone:864-984-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility