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General NPI Number Information
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NPI Number | 1518189877
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Entity Type | Organization
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Legal Business Name | LAKESHORE MEDICAL & HOME HEALTH SUPPLY CORPORATION
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5664 RICHMOND AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-3160
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Country | US
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Telephone | 231-788-1448
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Fax |
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Provider Business Mailing Address
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Address Line | 5664 RICHMOND AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-3160
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Country | US
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Telephone | 231-788-1448
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MR. THOMAS DONALD DOTSON SR.
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Credential |
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Telephone | 231-788-1448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 05775D
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License Number State | MI
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