Provider Demographics
NPI:1972689172
Name:LAKE HOSPITAL SYSTEM INC
Entity Type:Organization
Organization Name:LAKE HOSPITAL SYSTEM INC
Other - Org Name:LAKE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL PLANNING
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRILLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-767-8141
Mailing Address - Street 1:PO BOX 772930
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2930
Mailing Address - Country:US
Mailing Address - Phone:440-953-9600
Mailing Address - Fax:440-953-6081
Practice Address - Street 1:36000 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4662
Practice Address - Country:US
Practice Address - Phone:440-953-9600
Practice Address - Fax:440-953-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011437050002Medicaid
CAXHSP43687Medicaid
MT016066904Medicaid
NE10024977600Medicaid
ID807020000Medicaid
FL909509800Medicaid
ALLAK0098NMedicaid
NYD2490320Medicaid
NC3600098Medicaid
AZ803272Medicaid
GA816807662AMedicaid
OH4922507Medicaid
CAXHSP33687Medicaid
KY0140D446Medicaid
NYD2490320Medicaid
IL=========001Medicaid