Provider Demographics
NPI:1932114592
Name:LAKESHORE ESTATES, INC.
Entity Type:Organization
Organization Name:LAKESHORE ESTATES, INC.
Other - Org Name:LAKESHORE MEADOWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-646-4466
Mailing Address - Street 1:8044 COLEY DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2310
Mailing Address - Country:US
Mailing Address - Phone:615-646-4466
Mailing Address - Fax:615-662-3235
Practice Address - Street 1:8044 COLEY DAVIS RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2310
Practice Address - Country:US
Practice Address - Phone:615-646-4466
Practice Address - Fax:615-662-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN399310400000X
TN59313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility