Provider Demographics
NPI:1396804829
Name:LAUREL SENIOR CENTER, INC.
Entity type:Organization
Organization Name:LAUREL SENIOR CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-875-2536
Mailing Address - Street 1:113 N. CENTRAL AVENUE
Mailing Address - Street 2:P.O. BO X 64
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-0064
Mailing Address - Country:US
Mailing Address - Phone:302-875-2536
Mailing Address - Fax:302-875-2883
Practice Address - Street 1:113 N. CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-0064
Practice Address - Country:US
Practice Address - Phone:302-875-2536
Practice Address - Fax:302-875-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEADC-006103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000834455Medicaid