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General NPI Number Information
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NPI Number | 1568514636
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Entity Type | Organization
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Legal Business Name | LAKE HOSPITAL SYSTEM, INC.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 9485 MENTOR AVE SUITE A04
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City | MENTOR
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State | OH
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Zip | 44060-4597
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Country | US
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Telephone | 440-639-0900
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Fax | 440-357-4583
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Provider Business Mailing Address
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Address Line | 7590 AUBURN RD
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City | CONCORD TWP
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State | OH
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Zip | 44077-9176
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Country | US
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Telephone | 440-375-8700
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Fax | 440-354-1994
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Authorized Official
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Title or Position | VP FINANCE, CFO
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Name | MR. MICHAEL KITTOE
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Credential |
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Telephone | 440-354-1051
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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 |
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License Number State |
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