Healthcare Provider Details

I. General information

NPI: 1134125131
Provider Name (Legal Business Name): LAKE ORION NURSING CENTER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 E FLINT ST
LAKE ORION MI
48362-3209
US

IV. Provider business mailing address

585 E FLINT ST
LAKE ORION MI
48362-3209
US

V. Phone/Fax

Practice location:
  • Phone: 248-693-0505
  • Fax: 248-693-6071
Mailing address:
  • Phone: 248-693-0505
  • Fax: 248-693-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number634024
License Number StateMI

VIII. Authorized Official

Name: MR. MATT LEGAULT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 248-338-5691