Organization
THE LAURELS OF CHARLOTTESVILLE, LLC
Active
Other names
THE LAURELS OF CHARLOTTESVILLE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY PATTON (CFO)
(614) 794-8800
Entity
Organization
Contact information
Practice address
1165 PEPSI PL, CHARLOTTESVILLE, VA 22901-2866
(434) 951-4200
(434) 951-4201
Mailing address
1165 PEPSI PL, CHARLOTTESVILLE, VA 22901-2866
(434) 951-4200
(434) 951-4201
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
NH2754
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147664
BC/BS #
VA
01
—
7105596
UNITED HEALTH CARE ID #
VA
01
—
NH2754
NH LICENSE #
VA
Enumeration date
10/25/2006
Last updated
10/05/2007
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