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General NPI Number Information
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NPI Number | 1114889045
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Entity Type | Organization
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Legal Business Name | LAKE LIFE AFC LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 6844 W REDMAN DR
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City | LAKE CITY
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State | MI
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Zip | 49651-8517
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Country | US
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Telephone | 231-667-7601
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Fax |
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Provider Business Mailing Address
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Address Line | 6752 E HOUGHTON LAKE RD
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City | MERRITT
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State | MI
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Zip | 49667-9743
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Country | US
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Telephone | 231-667-7601
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSEE
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Name | SARAH L BARNES
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Credential |
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Telephone | 231-667-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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