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General NPI Number Information
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NPI Number | 1043369481
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Entity Type | Organization
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Legal Business Name | LAKESHORE COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1350 W 26TH ST
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City | ERIE
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State | PA
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Zip | 16508-1402
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Country | US
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Telephone | 814-456-9962
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Fax | 814-456-0595
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Provider Business Mailing Address
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Address Line | 1350 W 26TH ST
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City | ERIE
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State | PA
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Zip | 16508-1402
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Country | US
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Telephone | 814-456-9962
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Fax | 814-456-0595
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Authorized Official
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Title or Position | CEO
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Name | MR. RICHARD A. RUEDY
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Credential |
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Telephone | 814-456-9962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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