LAKE SHORE AFC, LLC (NPI# 1669968129) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669968129 |
| Entity Type | Organization |
| Organization Name | LAKE SHORE AFC, LLC |
| Other Organization Name | LAKE SHORE AFC, LLC |
| Practice Address |
2480 Tonawanda Lake Rd Grawn MI 49637-9615 |
| Mailing Address |
Po Box 119 Grawn MI 49637-0119 |
| Practice Telephone | 2312769260 |
| Practice Fax Number | 2312769380 |
| Mailing Telephone | 2312769260 |
| Mailing Fax Number | 2312769380 |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-07-09 |
| Authorized Official Name | MR. RANDY JOHN SCHOLTUS (ADMINISTRATOR) |
| Authorized Official Telephone | 2312769260 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
AM280289926 | MI | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Lake Shore AFC, LLC | Doing Business As Name - Organization |
| Street Address |
2480 TONAWANDA LAKE RD |
| City | GRAWN |
| State | MI |
| Zip Code | 49637-9615 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528147519 | Glen Arbor Township | Ambulance | 6401 West State St, Glen Arbor, MI 49637 | 2006-11-02 |
| 1447339411 | Township of Blair | Ambulance | 2121 Co Rd 633, Grawn, MI 49637-9406 | 2006-11-02 |
| 1407058928 | Cutting Edge Eyewear | Eyewear Supplier (Equipment, not the service) | 1525 County Road 633, Suite B, Grawn, MI 49637-9450 | 2007-06-05 |
| 1578065603 | Ashley Curtis Tarras | Occupational Therapist | 6155 Jeffrey Pl, Grawn, MI 49637-9557 | 2018-03-05 |
| 1558801118 | West Shore Homes Afc, LLC | Custodial Care Facility | 2651 Leaf Ln, Grawn, MI 49637-9605 | 2017-03-02 |
| 1902076581 | Great Lakes Medical Transport | Secured Medical Transport (VAN) | 2600 Tonawanda Lake Rd, Grawn, MI 49637-9616 | 2008-03-10 |
| 1043315492 | Deborah Warren | Family Medicine | 6176 Us Highway 31, Grawn, MI 49637-9620 | 2006-09-13 |
| 1871736710 | Health At Its Best, Pllc | Family Medicine | 6176 Us Highway 31, Grawn, MI 49637-9620 | 2009-04-08 |
| 1518279512 | Joan Elizabeth Metropoulos | Physical Therapy Assistant | 2351 Sadie Ln, Grawn, MI 49637-9694 | 2010-07-07 |
| 1043755135 | Adam Devaney | Social Worker | 1488 Mcgregor Way, Grawn, MI 49637-9697 | 2016-12-27 |
| Find all providers in zip 49637 | ||||
| Taxonomy Code | 3104A0630X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Behavioral Disturbances |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770131344 | Garth Hutton | Assisted Living Facility | 1404 Territorial Rd W, Battle Creek, MI 49015-2751 | 2019-08-27 |
| 1053837922 | Raekesha Lachelle Mcmillian | Assisted Living Facility | 820 Watkins St Se, Grand Rapids, MI 49507-1345 | 2017-08-22 |
| 1942691191 | Stoneridge Adult Foster Care | Assisted Living Facility | 4825 Fruin Rd, Bellevue, MI 49021-8209 | 2015-02-10 |
| 1942605746 | D & J Home Care 3, LLC | Assisted Living Facility | 33255 26 Mile Rd, Lenox, MI 48048-2904 | 2014-10-23 |
| 1043614852 | D & J Home Care, Inc. | Assisted Living Facility | 5485 Smiths Creek Rd, Kimball, MI 48074-3811 | 2014-10-22 |
| 1689004921 | Niche Aging Center | Assisted Living Facility | 3405 E Midland Rd, Bay City, MI 48706-2825 | 2013-11-23 |
| 1992135313 | Bavarian Comfort Care | Assisted Living Facility | 5366 W Rolling Hills Dr, Bridgeport, MI 48722-9671 | 2013-11-21 |
| 1184803678 | Dianes Sweet Home,inc | Assisted Living Facility | 7750 Carpenter Rd, Ypsilanti, MI 48197-8847 | 2007-10-31 |
| 1760677751 | Mastrofrancesco Afc Inc | Assisted Living Facility | 18787 Ray St, Riverview, MI 48193-7428 | 2007-09-12 |
| 1295800779 | Samaritan Homes Inc | Assisted Living Facility | 25160 Lahser Rd Ste 221, Southfield, MI 48034-6302 | 2006-11-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.