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Organization
LAKESHORE RESPIRATORY THERAPY CARE SERVICES, INC
Active
Organization
LAKESHORE RESPIRATORY THERAPY CARE SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL HAILE REGISTERED NURSE (OFFICER)
(820) 683-2068
Entity
Organization
Contact information
Practice address
3203 LINCOLN AVE STE 2, TWO RIVERS, WI 54241-1821
(820) 683-2068
(920) 683-9238
Mailing address
3203 LINCOLN AVE STE 2, TWO RIVERS, WI 54241-1821
(820) 683-2068
(920) 683-9238
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
9207-045
WI
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
9207-45
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9207-045
STATE DISTRIBUTOR LICENSE
WI
Enumeration date
10/27/2006
Last updated
07/26/2018
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