Organization
LAKESHORE COMMUNITY HEALTH CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CALEB JENSEMA (CFO)
(920) 783-6633
Entity
Organization
Contact information
Practice address
908 W WASHINGTON ST, WEST BEND, WI 53095-2430
(920) 783-6633
Mailing address
PO BOX 959, SHEBOYGAN, WI 53082-0959
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
07/15/2022
Last updated
07/15/2022
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