Healthcare Provider Details

I. General information

NPI: 1902715295
Provider Name (Legal Business Name): LAKEWELL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GREENFIELD RD STE 300
DEARBORN MI
48120-1805
US

IV. Provider business mailing address

3200 GREENFIELD RD STE 300
DEARBORN MI
48120-1805
US

V. Phone/Fax

Practice location:
  • Phone: 231-310-5050
  • Fax:
Mailing address:
  • Phone: 231-310-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ABDIRAHMAN ABDILADIF ALI
Title or Position: MANAGING DIRECTOR
Credential: MD
Phone: 612-496-8493