Provider Demographics
NPI:1073589230
Name:LAKETOP INC.
Entity Type:Organization
Organization Name:LAKETOP INC.
Other - Org Name:BRIGHTER DAYS HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AJIBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGEDENGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-960-0048
Mailing Address - Street 1:900 RIDGE ROAD
Mailing Address - Street 2:SUITE 3NW
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1937
Mailing Address - Country:US
Mailing Address - Phone:708-960-0048
Mailing Address - Fax:708-960-4243
Practice Address - Street 1:900 RIDGE ROAD
Practice Address - Street 2:SUITE 3NW
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1937
Practice Address - Country:US
Practice Address - Phone:708-960-0048
Practice Address - Fax:708-960-4243
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKETOP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-27
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011716251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL760761822Medicaid
IL50392OtherBCBS
IL760761822Medicaid