Organization
SCG LAURELLWOOD LLC
Active
Other names
LaurellWood Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID ROSS VAUGHAN (CHAIRMAN OF THE BOARD)
(813) 341-2700
Entity
Organization
Contact information
Practice address
3127 57TH AVE N, ST PETERSBURG, FL 33714
(727) 527-2171
(727) 522-5929
Mailing address
1240 MARBELLA PLAZA DR, TAMPA, FL 33619
(813) 341-2700
(813) 341-2755
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031662800
—
FL
Enumeration date
08/10/2005
Last updated
02/26/2015
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