MEDICARE: LAKE HURON CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1780546952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE HURON CENTER LLC

Provider Business Mailing Address
First Line	:	11445 KENMOOR ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-3221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11445 KENMOOR ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-3221
Country	:	US
Telephone Number	:	941-592-3725
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SABRINA CAUVIN
Credential	:
Telephone Number	:	941-592-3725

Provider Enumeration Date	:	11/26/2025
Last Update Date	:	12/02/2025

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Directions to “LAKE HURON CENTER LLC ” Practice Location

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