Provider Demographics
NPI:1962592105
Name:LAUREL HEALTH CARE COMPANY OF GALESBURG
Entity type:Organization
Organization Name:LAUREL HEALTH CARE COMPANY OF GALESBURG
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 1:1080 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-9727
Mailing Address - Country:US
Mailing Address - Phone:616-665-7043
Mailing Address - Fax:616-665-4080
Practice Address - Street 1:1080 N 35TH ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:MI
Practice Address - Zip Code:49053-9727
Practice Address - Country:US
Practice Address - Phone:616-665-7043
Practice Address - Fax:616-665-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI394150332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3319728Medicaid
MI7105582OtherUNITED HEALTH CARE ID #
MI1204620001Medicare NSC