1295013977 NPI number — LAKESHORE HOSPICE CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295013977 NPI number — LAKESHORE HOSPICE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKESHORE HOSPICE CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295013977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1380 E MAIN ST STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMORE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48829-8339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1380 E MAIN ST STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMORE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48829-8339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-560-7500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RATHOD
Authorized Official First Name:
SHAILA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-560-7500

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  03843K , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03843K . This is a "STATE ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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