Provider Demographics
NPI:1194021055
Name:LAKESHORE HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:LAKESHORE HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-772-5000
Mailing Address - Street 1:1105 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3914
Mailing Address - Country:US
Mailing Address - Phone:989-772-5000
Mailing Address - Fax:989-772-5005
Practice Address - Street 1:1105 S MISSION ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3914
Practice Address - Country:US
Practice Address - Phone:989-772-5000
Practice Address - Fax:989-772-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI03770L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI03770LOtherMICHIGAN STATE ID
MI239248Medicare Oscar/Certification