Provider Demographics
NPI:1922537364
Name:LOURDES ALZHEIMER'S SPECIAL CARE
Entity Type:Organization
Organization Name:LOURDES ALZHEIMER'S SPECIAL CARE
Other - Org Name:CLAUSEN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARRARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-886-5102
Mailing Address - Street 1:2400 WATKINS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1427
Mailing Address - Country:US
Mailing Address - Phone:248-674-4732
Mailing Address - Fax:248-618-6269
Practice Address - Street 1:2400 WATKINS LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328
Practice Address - Country:US
Practice Address - Phone:248-674-4732
Practice Address - Fax:248-618-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL630007360311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAL630007360OtherADULT FOSTER CARE