Provider Demographics
NPI:1215982525
Name:LAUREL HEALTH CARE COMPANY OF CHATHAM NORTH CAROLINA, INC
Entity type:Organization
Organization Name:LAUREL HEALTH CARE COMPANY OF CHATHAM NORTH CAROLINA, INC
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:614-794-8800
Mailing Address - Street 1:8181 WORTHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8067
Mailing Address - Country:US
Mailing Address - Phone:614-794-8800
Mailing Address - Fax:614-794-8826
Practice Address - Street 1:72 CHATHAM BUSINESS DR
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-5687
Practice Address - Country:US
Practice Address - Phone:919-542-6677
Practice Address - Fax:919-542-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0523313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNH0523OtherNURSING HOME LICENSE #
NC0099MOtherBLUE CROSS BLUE SHIELD #
NC3415421Medicaid
NC341601JMedicaid
NC341601JMedicaid