Organization
LAKE SHORE AFC, LLC
Active
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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