Organization
THE LAURELS OF ROCKFORD, INC.
Active
Other names
THE LAURELS OF SHANE HILL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY PATTON (CFO)
(614) 794-8800
Entity
Organization
Contact information
Practice address
10731 STATE ROUTE 118, ROCKFORD, OH 45882-8947
(419) 363-2620
(419) 363-2354
Mailing address
10731 STATE ROUTE 118, ROCKFORD, OH 45882-8947
(419) 363-2620
(419) 363-2354
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
5801
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000253127
BC/BS #
OH
05
—
2165286
—
OH
01
—
5801
NH LICENSE #
OH
01
—
7105594
UNITED HEALTH CARE ID #
OH
Enumeration date
10/20/2006
Last updated
10/05/2007
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