Provider Demographics
NPI:1285076273
Name:LAKESHORE HEALTHCARE ELMWOOD CAMPUS INC
Entity type:Organization
Organization Name:LAKESHORE HEALTHCARE ELMWOOD CAMPUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V P OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:PMP
Authorized Official - Phone:313-483-3905
Mailing Address - Street 1:1881 E GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48211-3041
Mailing Address - Country:US
Mailing Address - Phone:313-922-1600
Mailing Address - Fax:313-922-4756
Practice Address - Street 1:1881 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-3041
Practice Address - Country:US
Practice Address - Phone:313-922-1600
Practice Address - Fax:313-922-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility