Provider Demographics
NPI:1669596284
Name:LAKESHORE HOME HEALTH CARE SERVICES, INC.
Entity type:Organization
Organization Name:LAKESHORE HOME HEALTH CARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO.OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-2527
Mailing Address - Street 1:5571 EAST APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3071
Mailing Address - Country:US
Mailing Address - Phone:231-728-4353
Mailing Address - Fax:231-728-4370
Practice Address - Street 1:5571 EAST APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3071
Practice Address - Country:US
Practice Address - Phone:231-728-4353
Practice Address - Fax:231-728-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4364218Medicaid
MI4801242Medicaid
MI4801251Medicaid