Organization
THE LAURELS OF UNIVERSITY PARK, LLC
Active
Other names
THE LAURELS OF UNIVERSITY PARK
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY PATTON (CFO)
(614) 794-8800
Entity
Organization
Contact information
Practice address
2420 PEMBERTON RD, RICHMOND, VA 23233-2006
(804) 747-9200
Mailing address
2420 PEMBERTON RD, RICHMOND, VA 23233-2006
(804) 747-9200
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
NH2705
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
221246
ANTHEM BC/BS
VA
05
—
4951093
—
VA
01
—
NH2705
NH LICENSE #
VA
Enumeration date
10/06/2006
Last updated
08/22/2020
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