Provider Demographics
NPI:1760602668
Name:LAKELAND NEURO CARE CENTER PTR
Entity Type:Organization
Organization Name:LAKELAND NEURO CARE CENTER PTR
Other - Org Name:THE LAKELAND CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:COO & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:ROMANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-350-8070
Mailing Address - Street 1:26900 FRANKLIN RD.
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033
Mailing Address - Country:US
Mailing Address - Phone:248-350-8070
Mailing Address - Fax:248-350-9734
Practice Address - Street 1:26900 FRANKLIN RD.
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033
Practice Address - Country:US
Practice Address - Phone:248-350-8070
Practice Address - Fax:248-350-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI604846736Medicaid
MI236831Medicare Oscar/Certification
MI235589Medicare Oscar/Certification