Provider Demographics
NPI:1013460831
Name:LAUREL CREEK HEALTHCARE AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:LAUREL CREEK HEALTHCARE AND REHABILITATION CENTER LLC
Other - Org Name:LAUREL CREEK HEALTHCARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-635-1195
Mailing Address - Street 1:1033 N HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-5478
Mailing Address - Country:US
Mailing Address - Phone:606-598-6163
Mailing Address - Fax:606-598-6164
Practice Address - Street 1:1033 N HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-5478
Practice Address - Country:US
Practice Address - Phone:606-598-6163
Practice Address - Fax:606-598-6164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
185293Medicare Oscar/Certification