Healthcare Provider Details

I. General information

NPI: 1548868011
Provider Name (Legal Business Name): LAKESHORE HELPING HANDS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 JEFFERSON ST
MANCELONA MI
49659-9329
US

IV. Provider business mailing address

PO BOX 555
MANCELONA MI
49659-0555
US

V. Phone/Fax

Practice location:
  • Phone: 231-463-0411
  • Fax:
Mailing address:
  • Phone: 231-463-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY DUPERON
Title or Position: OWNER
Credential:
Phone: 231-463-0411