Provider Demographics
NPI:1013545490
Name:LAKEFRONT NURSING MEDICAL STAFFING AGENCY LLC
Entity Type:Organization
Organization Name:LAKEFRONT NURSING MEDICAL STAFFING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-703-0710
Mailing Address - Street 1:26300 SEVILLE DR APT 101
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7595
Mailing Address - Country:US
Mailing Address - Phone:440-703-0710
Mailing Address - Fax:
Practice Address - Street 1:26300 SEVILLE DR APT 101
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7595
Practice Address - Country:US
Practice Address - Phone:440-703-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251F00000XAgenciesHome InfusionGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No251J00000XAgenciesNursing Care