Provider Demographics
NPI:1104872977
Name:LAUREL HEALTH CARE COMPANY OF PERRINTON
Entity type:Organization
Organization Name:LAUREL HEALTH CARE COMPANY OF PERRINTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-386-0300
Mailing Address - Street 1:4000 TOWN CTR STE 2000
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1415
Mailing Address - Country:US
Mailing Address - Phone:248-386-0300
Mailing Address - Fax:
Practice Address - Street 1:RFD #1
Practice Address - Street 2:4735 RANGER RD
Practice Address - City:PERRINTON
Practice Address - State:MI
Practice Address - Zip Code:48871
Practice Address - Country:US
Practice Address - Phone:989-236-5433
Practice Address - Fax:989-236-7672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI294010313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI294010OtherNURSING HOME LICENSE #
MI3202046Medicaid
MI09906OtherBLUE CROSS BLUE SHIELD #
MI294010OtherNURSING HOME LICENSE #