Provider Demographics
NPI:1013446459
Name:LOURDES ASSISTED LIVING
Entity Type:Organization
Organization Name:LOURDES ASSISTED LIVING
Other - Org Name:MENDELSON HOME
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 1:2450 WATKINS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1470
Mailing Address - Country:US
Mailing Address - Phone:248-618-6362
Mailing Address - Fax:248-618-6361
Practice Address - Street 1:2450 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:248-618-6362
Practice Address - Fax:248-618-6361
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
MIAH630236917310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAH630236917OtherHOME FOR THE AGED