# LAKESIDE MANOR NURSING & REHABILITATION CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013382225
- **Authorized official:** FAHIM UDDIN (PRESIDENT)
- **Authorized official phone:** (248) 593-1990

## Contact information

- **Practice address:** 13990 LAKESIDE CIR, STERLING HEIGHTS, MI 48313-1318
- **Practice address phone:** (586) 488-1400
- **Practice address fax:** (844) 276-4323
- **Mailing address:** 30700 TELEGRAPH RD, SUITE 2504, BINGHAM FARMS, MI 48025-4524
- **Mailing address phone:** (248) 593-1990
- **Mailing address fax:** (248) 593-9120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 12/14/2015
- **Last updated:** 02/10/2017