# LAUREL HEALTH CARE COMPANY OF GALESBURG

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE LAURELS OF GALESBURG
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114972734
- **Authorized official:** ANIS KHAN (CFO)
- **Authorized official phone:** (248) 386-0300

## Contact information

- **Practice address:** 1080 N 35TH ST, GALESBURG, MI 49053-9727
- **Practice address phone:** (616) 665-7043
- **Practice address fax:** (616) 665-4080
- **Mailing address:** 4000 TOWN CTR STE 2000, SOUTHFIELD, MI 48075-1415
- **Mailing address phone:** (248) 386-0300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 394150 | MI | — |
| 314000000X | Skilled Nursing Facility | 394150 | MI | Yes |

## Other

- **Enumeration date:** 05/23/2006
- **Last updated:** 09/13/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 09796 | BLUE CROSS BLUE SHIELD \# | MI |
| 05 | — | 3319728 | — | MI |
| 01 | — | 394150 | NURSING HOME LICENSE \# | MI |