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General NPI Number Information
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NPI Number | 1831957943
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Entity Type | Organization
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Legal Business Name | LAKESHORE CARE
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Dates
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Enumeration Date | 03/12/2024
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 918 W LAKE ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2857
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Country | US
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Telephone | 651-352-0147
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Fax |
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Provider Business Mailing Address
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Address Line | 918 W LAKE ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2857
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | INACTIVE INACTIVE
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Credential |
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Telephone | 612-333-1233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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