Provider Demographics
NPI:1366844284
Name:LAKE HOSPITAL SYSTEM, INC. DBA LAKE HEALTH
Entity Type:Organization
Organization Name:LAKE HOSPITAL SYSTEM, INC. DBA LAKE HEALTH
Other - Org Name:LAKE HEALTH PHARMACY - TRIPOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-354-1051
Mailing Address - Street 1:7580 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9615
Mailing Address - Country:US
Mailing Address - Phone:440-602-6320
Mailing Address - Fax:
Practice Address - Street 1:7580 AUBURN RD
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44077-9615
Practice Address - Country:US
Practice Address - Phone:440-602-6320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE HOSPITAL SYSTEM, INC. DBA LAKE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02445650 033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy