Provider Demographics
NPI:1275049116
Name:LAKE TOWN HOMECARE, LLC
Entity Type:Organization
Organization Name:LAKE TOWN HOMECARE, LLC
Other - Org Name:LAKE TOWN HOMECARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-892-1613
Mailing Address - Street 1:2121 NICOLLET AVE S SUITE 6
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:619-246-0239
Mailing Address - Fax:
Practice Address - Street 1:4119 SCOTT AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:619-892-1613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care