Organization
LAKESHORE CARE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY G ADAMS (PRESIDENT)
(616) 813-5471
Entity
Organization
Contact information
Practice address
8840 CEDAR CREEK DR, HOLTON, MI 49425-8599
(231) 821-0281
(231) 821-0281
Mailing address
304 MADISON AVE SE, GRAND RAPIDS, MI 49503-4618
(616) 459-9331
(616) 459-9331
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AM610080832
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5983515
—
MI
Enumeration date
09/23/2013
Last updated
09/25/2013
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