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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