Provider Demographics
NPI:1063973394
Name:LAURENS DSN BOARD
Entity type:Organization
Organization Name:LAURENS DSN BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-683-5626
Mailing Address - Street 1:1860 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-5160
Mailing Address - Country:US
Mailing Address - Phone:864-683-5626
Mailing Address - Fax:
Practice Address - Street 1:1860 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-5160
Practice Address - Country:US
Practice Address - Phone:864-683-5626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency