Provider Demographics
NPI:1700657905
Name:NORTH SHORES CENTER, LLC
Entity Type:Organization
Organization Name:NORTH SHORES CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICEE
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOURDAIS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:989-493-1451
Mailing Address - Street 1:4424 WINTERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8673
Mailing Address - Country:US
Mailing Address - Phone:989-493-1451
Mailing Address - Fax:
Practice Address - Street 1:118 MCLOUTH RD
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9339
Practice Address - Country:US
Practice Address - Phone:989-598-7435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH SHORES CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility