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General NPI Number Information
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NPI Number | 1578108643
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Entity Type | Organization
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Legal Business Name | LAKESTATE INDUSTRIES
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 1830 N 21ST ST
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City | ESCANABA
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State | MI
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Zip | 49829-9586
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Country | US
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Telephone | 906-786-9212
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 279
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City | ESCANABA
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State | MI
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Zip | 49829-0279
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Country | US
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Telephone | 906-786-9212
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Fax | 906-789-6004
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHERYL GERISE OHMAN
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Credential |
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Telephone | 906-786-9212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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