Provider Demographics
NPI:1346244399
Name:LAKESIDE HOSPICE INC.
Entity type:Organization
Organization Name:LAKESIDE HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-884-1111
Mailing Address - Street 1:4010 MASTERS RD
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128-7550
Mailing Address - Country:US
Mailing Address - Phone:205-884-1111
Mailing Address - Fax:205-884-1114
Practice Address - Street 1:4010 MASTERS RD
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35128-7550
Practice Address - Country:US
Practice Address - Phone:205-884-1111
Practice Address - Fax:205-884-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10266251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP1C1526EMedicaid
AL010-727OtherBCBS
AL010-727OtherBCBS