Healthcare Provider Details

I. General information

NPI: 1316875347
Provider Name (Legal Business Name): SILVER LAKE VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SCAMMEL ST
MARIETTA OH
45750-2938
US

IV. Provider business mailing address

2891 SILVER ST
GRANVILLE OH
43023-9366
US

V. Phone/Fax

Practice location:
  • Phone: 740-398-4585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LUKE FRESHWATER
Title or Position: PRESIDENT
Credential:
Phone: 740-398-4585