Organization
LAKESHORE REGIONAL ENTITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY ALAN LABAN II (CFO)
(231) 769-2046
Entity
Organization
Contact information
Practice address
920 DIANA ST, LUDINGTON, MI 49431-1987
(231) 845-6294
(231) 845-7095
Mailing address
5000 HAKES DR., SUITE 500, NORTON SHORES, MI 49441
(231) 769-2046
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/02/2013
Last updated
11/01/2016
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