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General NPI Number Information
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NPI Number | 1285755793
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Entity Type | Organization
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Legal Business Name | LAKELAND HOUSE, INC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1052 BYRON DR
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City | TROY
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State | MI
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Zip | 48098-4420
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Country | US
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Telephone | 248-952-5821
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Fax |
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Provider Business Mailing Address
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Address Line | 26900 FRANKLIN RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-5312
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Country | US
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Telephone | 248-350-8070
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Fax |
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Authorized Official
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Title or Position | COO & CFO
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Name | MR. GARY ERNEST ROMANELLI
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Credential |
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Telephone | 248-350-8070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MI
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