Provider Demographics
NPI:1447562103
Name:LAKESHORE HOME CARE, INC.
Entity Type:Organization
Organization Name:LAKESHORE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HARDIP
Authorized Official - Middle Name:
Authorized Official - Last Name:JADAV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-763-1300
Mailing Address - Street 1:614 ROMENCE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3613
Mailing Address - Country:US
Mailing Address - Phone:269-343-5555
Mailing Address - Fax:269-343-5599
Practice Address - Street 1:614 ROMENCE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3613
Practice Address - Country:US
Practice Address - Phone:269-343-5555
Practice Address - Fax:269-343-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID