Provider Demographics
NPI:1396183372
Name:LAKESHORE CAP, INC.
Entity Type:Organization
Organization Name:LAKESHORE CAP, INC.
Other - Org Name:LAKESHORE FAMILY RESOURCES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VETTE
Authorized Official - Last Name:HUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-686-8705
Mailing Address - Street 1:702 STATE ST
Mailing Address - Street 2:PO BOX 2315
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4034
Mailing Address - Country:US
Mailing Address - Phone:920-682-3737
Mailing Address - Fax:920-686-8700
Practice Address - Street 1:702 STATE ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4034
Practice Address - Country:US
Practice Address - Phone:920-682-3737
Practice Address - Fax:920-686-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare