Provider Demographics
NPI:1578108643
Name:LAKESTATE INDUSTRIES
Entity Type:Organization
Organization Name:LAKESTATE INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:GERISE
Authorized Official - Last Name:OHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-786-9212
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-0279
Mailing Address - Country:US
Mailing Address - Phone:906-786-9212
Mailing Address - Fax:906-789-6004
Practice Address - Street 1:1830 N 21ST ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-9586
Practice Address - Country:US
Practice Address - Phone:906-786-9212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty