Healthcare Provider Details

I. General information

NPI: 1376407320
Provider Name (Legal Business Name): LAKE SHORE MEDICAL RIDES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 N LARCHMONT DR
SANDUSKY OH
44870-4320
US

IV. Provider business mailing address

1655 N LARCHMONT DR
SANDUSKY OH
44870-4320
US

V. Phone/Fax

Practice location:
  • Phone: 419-239-7379
  • Fax:
Mailing address:
  • Phone: 419-239-7379
  • 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: EDDRINA NICKCOLE WALKER
Title or Position: CEO/OWNER
Credential:
Phone: 419-239-7379