Provider Demographics
NPI:1932260700
Name:LAUREL HOUSING INC
Entity Type:Organization
Organization Name:LAUREL HOUSING INC
Other - Org Name:LAUREL HEIGHTS NURSING HOME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-864-4155
Mailing Address - Street 1:208 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1101
Mailing Address - Country:US
Mailing Address - Phone:606-864-4155
Mailing Address - Fax:606-864-1135
Practice Address - Street 1:208 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1101
Practice Address - Country:US
Practice Address - Phone:606-864-4155
Practice Address - Fax:606-864-1135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP018063336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2030568OtherPK
KY54019625Medicaid