Organization
LAKESIDE COMPREHENSIVE REHABILITATION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH WINDELL O.T.R.L (OWNER/O.T.R.L)
(231) 873-3577
Entity
Organization
Contact information
Practice address
601 E MAIN ST, HART, MI 49420-1144
(231) 873-3577
(231) 873-3557
Mailing address
601 E MAIN ST, HART, MI 49420-1144
(231) 873-3577
(231) 873-3557
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007770495
AETNA PIN
MI
01
—
0704110
UNITED HEALTHCARE GROUP #
MI
01
—
177403453814
HUMANA ID
MI
01
—
650F410300
BCBSM PIN
MI
Enumeration date
07/11/2006
Last updated
03/25/2015
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