Provider Demographics
NPI:1386731610
Name:THE LAURELS OF SUMMITT INN, INC.
Entity type:Organization
Organization Name:THE LAURELS OF SUMMITT INN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-794-8800
Mailing Address - Street 1:100 RICEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2122
Mailing Address - Country:US
Mailing Address - Phone:828-299-1110
Mailing Address - Fax:828-299-4077
Practice Address - Street 1:100 RICEVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2122
Practice Address - Country:US
Practice Address - Phone:828-299-1110
Practice Address - Fax:828-299-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0540332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3425438Medicaid
NC0094XOtherBC/BS #
NC923379OtherFACILITY ID #
NC7100176OtherUNITED HEALTH CARE ID #
NCNH0540OtherNH LICENSE #
NC4321090001Medicare NSC