Provider Demographics
NPI:1912529876
Name:AH LAKESIDE II LDHA LLC
Entity Type:Organization
Organization Name:AH LAKESIDE II LDHA LLC
Other - Org Name:BALDWIN HOUSE LAKESIDE II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-263-0081
Mailing Address - Street 1:15821 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6320
Mailing Address - Country:US
Mailing Address - Phone:586-263-0081
Mailing Address - Fax:586-412-1672
Practice Address - Street 1:15821 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6320
Practice Address - Country:US
Practice Address - Phone:586-263-0081
Practice Address - Fax:586-412-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332U00000XSuppliersHome Delivered MealsGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty