MEDICARE: LAKESHORE CARE

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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1831957943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE CARE

Provider Business Mailing Address
First Line	:	918 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2857
Country	:	US
Telephone Number	:	651-352-0147
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	INACTIVE INACTIVE
Credential	:
Telephone Number	:	612-333-1233

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	01/26/2026

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Directions to “LAKESHORE CARE ” Practice Location

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