Organization
LAKE SHORE AFC, LLC
Active
Other names
Lake Shore AFC, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY JOHN SCHOLTUS (ADMINISTRATOR)
(231) 276-9260
Entity
Organization
Contact information
Practice address
2480 TONAWANDA LAKE RD, GRAWN, MI 49637-9615
(231) 276-9260
(231) 276-9380
Mailing address
PO BOX 119, GRAWN, MI 49637-0119
(231) 276-9260
(231) 276-9380
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
AM280289926
MI
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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