Provider Demographics
NPI:1093720757
Name:LAKESHORE ESTATES, INC.
Entity Type:Organization
Organization Name:LAKESHORE ESTATES, INC.
Other - Org Name:LAKESHORE HEARTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCIORTINO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:615-646-4466
Mailing Address - Street 1:3025 FERNBROOK LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-1623
Mailing Address - Country:US
Mailing Address - Phone:615-885-2320
Mailing Address - Fax:615-885-3439
Practice Address - Street 1:3025 FERNBROOK LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-1623
Practice Address - Country:US
Practice Address - Phone:615-885-2320
Practice Address - Fax:615-885-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN396310400000X
TN56313M00000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440581Medicaid