The Laurels of Rockford, Inc.

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

License

5801 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

Oct 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Timothy Patton

Title

Cfo

Phone

(614) 794-8800

Specialties & licenses 1

Addresses

Other identifiers 4

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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191542400000",
    "number": "1952483455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "2006-10-20",
        "last_updated": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "PATTON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "614-794-8800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "OH",
            "license": "5801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE ID #",
            "identifier": "7105594",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NH LICENSE #",
            "identifier": "5801",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2165286",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS #",
            "identifier": "000000253127",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE LAURELS OF SHANE HILL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jerry D Sell, M.D.
• Shane Hill Divine Opco LLC
• Shane Hill Divine Opco LLC
• Shane Hill Rehabilitation and Nursing Center LLC
• The Laurels of Rockford, Inc.
• Van Wert Medical Services
• Christy A Whitaker
• Sydney Wilker

• Parenteral & Enteral Nutrition Supplies (DME) in Rockford, OH
• Providers in Rockford, OH by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; 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.