Lake Shore Afc, LLC

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

AM280289926 Issued in MI

Legal business name

LAKE SHORE AFC, LLC

Doing business as

Lake Shore AFC, LLC

Practice address

2480 Tonawanda Lake Rd
Grawn, MI 49637-9615

Phone

(231) 276-9260

Fax

(231) 276-9380

NPI assigned

Jul 9, 2018

Last updated

Jul 9, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Randy John Scholtus

Title

Administrator

Phone

(231) 276-9260

Specialties & licenses 1

Addresses

Other names 1

• Lake Shore AFC, LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531094400000",
    "number": "1669968129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 119",
            "city": "GRAWN",
            "state": "MI",
            "postal_code": "496370119",
            "telephone_number": "231-276-9260",
            "fax_number": "231-276-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 TONAWANDA LAKE RD",
            "city": "GRAWN",
            "state": "MI",
            "postal_code": "496379615",
            "telephone_number": "231-276-9260",
            "fax_number": "231-276-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE AFC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-09",
        "last_updated": "2018-07-09",
        "status": "A",
        "authorized_official_last_name": "SCHOLTUS",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "231-276-9260",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "MI",
            "license": "AM280289926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Shore AFC, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility (Behavioral Disturbances) in Grawn, MI
• Providers in Grawn, MI by specialty
• Assisted Living Facility (Behavioral Disturbances) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.