Provider Demographics
NPI:1912038829
Name:LAKESHORE COORDINATING COUNCIL
Entity Type:Organization
Organization Name:LAKESHORE COORDINATING COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGS HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-846-6720
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-0268
Mailing Address - Country:US
Mailing Address - Phone:616-846-6720
Mailing Address - Fax:616-846-5081
Practice Address - Street 1:324 WASHINGTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1397
Practice Address - Country:US
Practice Address - Phone:616-846-6720
Practice Address - Fax:616-846-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4455644Medicaid