Provider Demographics
NPI:1265154603
Name:LAKES HOMECARE LLC
Entity type:Organization
Organization Name:LAKES HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:EGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:161-270-2048
Mailing Address - Street 1:2400 BLAISDELL AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3331
Mailing Address - Country:US
Mailing Address - Phone:612-702-0481
Mailing Address - Fax:
Practice Address - Street 1:2400 BLAISDELL AVE STE 204
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3331
Practice Address - Country:US
Practice Address - Phone:612-702-0481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health