Organization
LAKESIDE PLACE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIAN FLOWERS FUNDERBURK (PRESIDENT/OWNER)
(704) 563-1341
Entity
Organization
Contact information
Practice address
7210 LAKESIDE DRIVE, NORTH, CHARLOTTE, NC 28215
(704) 563-1341
(704) 563-1341
Mailing address
7210 LAKESIDE DRIVE, NORTH, CHARLOTTE, NC 28215
(704) 563-1341
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
Primary
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
08/12/2021
Last updated
08/12/2021
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