Healthcare Provider Details

I. General information

NPI: 1508320276
Provider Name (Legal Business Name): HOME CARE SERVICES LAKESHORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E ELLIS RD STE 534
NORTON SHORES MI
49441-5622
US

IV. Provider business mailing address

800 E ELLIS RD STE 534
NORTON SHORES MI
49441-5622
US

V. Phone/Fax

Practice location:
  • Phone: 616-430-8744
  • Fax: 616-239-3001
Mailing address:
  • Phone: 616-430-8744
  • Fax: 616-239-3001

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: JEREMY FELLOWS
Title or Position: MEMBER
Credential:
Phone: 616-328-6680