Provider Demographics
NPI:1821098476
Name:ATRIO HOME HEALTH LAKESHORE
Entity Type:Organization
Organization Name:ATRIO HOME HEALTH LAKESHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-235-5015
Mailing Address - Street 1:2100 RAYBROOK ST SE
Mailing Address - Street 2:STE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 E 8TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3501
Practice Address - Country:US
Practice Address - Phone:616-796-3838
Practice Address - Fax:616-393-9817
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATRIO HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-26
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237411Medicare Oscar/Certification