Provider Demographics
NPI:1467572255
Name:LAKE SUPERIOR CONCIERGE, INC.
Entity Type:Organization
Organization Name:LAKE SUPERIOR CONCIERGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:LINDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:218-310-6779
Mailing Address - Street 1:5652 N CLOQUET RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55810-9566
Mailing Address - Country:US
Mailing Address - Phone:218-310-6779
Mailing Address - Fax:
Practice Address - Street 1:104 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-3000
Practice Address - Country:US
Practice Address - Phone:218-310-6779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health