Provider Demographics
NPI:1104100601
Name:LAKE HEALTH MEDICAL CENTER
Entity type:Organization
Organization Name:LAKE HEALTH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUTA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNP, FNP, RN
Authorized Official - Phone:440-354-1802
Mailing Address - Street 1:7580 AUBURN RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9615
Mailing Address - Country:US
Mailing Address - Phone:440-354-1802
Mailing Address - Fax:440-953-6138
Practice Address - Street 1:7580 AUBURN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9615
Practice Address - Country:US
Practice Address - Phone:440-953-6082
Practice Address - Fax:440-953-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363LF0000X282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital