=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295013977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKESHORE HOSPICE CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2011
-----------------------------------------------------
Last Update Date | 07/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1380 E MAIN ST STE E
-----------------------------------------------------
City | EDMORE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48829-8339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-560-7500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1380 E MAIN ST STE E
-----------------------------------------------------
City | EDMORE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48829-8339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. SHAILA B RATHOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-560-7500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 03843K
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------