Provider Demographics
NPI:1447347794
Name:LAUREL HEALTH CARE COMPANY OF WAYLAND
Entity type:Organization
Organization Name:LAUREL HEALTH CARE COMPANY OF WAYLAND
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 1:425 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1109
Mailing Address - Country:US
Mailing Address - Phone:616-792-2249
Mailing Address - Fax:616-792-6121
Practice Address - Street 1:425 E ELM ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1109
Practice Address - Country:US
Practice Address - Phone:616-792-2249
Practice Address - Fax:616-792-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0340303332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7105598OtherUNITED HEALTH CARE ID #
SC034030OtherNH LICENSE #
MI3202091Medicaid
MI1105160001Medicare NSC