# AH LAKESIDE I LDHA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Baldwin House Lakeside I
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386266245
- **Authorized official:** AUBREY BROHL (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (586) 263-0081

## Contact information

- **Practice address:** 15731 19 MILE RD, CLINTON TOWNSHIP, MI 48038-6315
- **Practice address phone:** (586) 263-0081
- **Practice address fax:** (586) 412-1672
- **Mailing address:** 15731 19 MILE RD, CLINTON TOWNSHIP, MI 48038-6315
- **Mailing address phone:** (586) 263-0081
- **Mailing address fax:** (586) 412-1672

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332U00000X | Home Delivered Meals | — | NULL | Yes |
| 376J00000X | Homemaker | — | NULL | — |
| 376J00000X | Homemaker | — | — | — |

## Other

- **Enumeration date:** 05/14/2020
- **Last updated:** 07/15/2021