The Laurels of Rockford, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1492N Issued in OH

Legal business name

THE LAURELS OF ROCKFORD, INC.

Doing business as

The Laurels of Shane Hill

Practice address

10731 State Route 118
Rockford, OH 45882-8947

Phone

(419) 363-2620

Fax

(419) 363-2354

NPI assigned

May 24, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Anis Khan

Title

Cfo

Phone

(614) 794-8800

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• THE LAURELS OF SHANE HILL Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466121600000",
    "number": "1205881661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8181 WORTHINGTON RD",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430828067",
            "telephone_number": "614-794-8800",
            "fax_number": "614-794-8826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10731 STATE ROUTE 118",
            "city": "ROCKFORD",
            "state": "OH",
            "postal_code": "458828947",
            "telephone_number": "419-363-2620",
            "fax_number": "419-363-2354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAURELS OF ROCKFORD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2016-06-17",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "ANIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "614-794-8800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OH",
            "license": "1492N",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1492N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2165286",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE LAURELS OF SHANE HILL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa Renee Rolfes, RN, NP
• Jerry D Sell, M.D.
• Shane Hill Divine Opco LLC
• Shane Hill Divine Opco LLC
• Shane Hill Rehabilitation and Nursing Center LLC (Divine Rehabilitation and Nursing Center at Shane Hill)
• The Laurels of Rockford, Inc. (The Laurels of Shane Hill)
• Van Wert Medical Services
• Christy A Whitaker
• Sydney Wilker

• Skilled Nursing Facility in Rockford, OH
• Providers in Rockford, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.