Provider Demographics
NPI:1225345978
Name:LAKEVIEW ADULT FOSTER CARE HOME
Entity Type:Organization
Organization Name:LAKEVIEW ADULT FOSTER CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-586-6934
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:CURTIS
Mailing Address - State:MI
Mailing Address - Zip Code:49820-0189
Mailing Address - Country:US
Mailing Address - Phone:906-586-6934
Mailing Address - Fax:906-586-6935
Practice Address - Street 1:W17345 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CURTIS
Practice Address - State:MI
Practice Address - Zip Code:49820
Practice Address - Country:US
Practice Address - Phone:906-586-6934
Practice Address - Fax:906-586-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM490290970320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities