| Lakeshore Regional Entity | |
|
920 Diana St Ludington MI 49431-1987 | |
| (231) 845-6294 | |
| (231) 845-7095 |
| Full Name | Lakeshore Regional Entity |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 920 Diana St, Ludington, Michigan |
| Authorized Official Name and Position | Jeffrey Alan Laban (CFO) |
| Authorized Official Contact | 2317692046 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Regional Entity 5000 Hakes Dr. Suite 500 Norton Shores MI 49441 Ph: (231) 769-2046 | Lakeshore Regional Entity 920 Diana St Ludington MI 49431-1987 Ph: (231) 845-6294 |
| NPI Number | 1083041297 |
|---|---|
| Provider Enumeration Date | 10/02/2013 |
| Last Update Date | 11/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083041297 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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