Provider Demographics
NPI:1508320276
Name:HOME CARE SERVICES LAKESHORE, LLC
Entity Type:Organization
Organization Name:HOME CARE SERVICES LAKESHORE, LLC
Other - Org Name:FIRSTLIGHT LAKESHORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-328-6680
Mailing Address - Street 1:800 E ELLIS RD STE 534
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5622
Mailing Address - Country:US
Mailing Address - Phone:616-430-8744
Mailing Address - Fax:616-239-3001
Practice Address - Street 1:800 E ELLIS RD STE 534
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5622
Practice Address - Country:US
Practice Address - Phone:616-430-8744
Practice Address - Fax:616-239-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care