Provider Demographics
NPI:1366211898
Name:LAKE SUPERIOR HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:LAKE SUPERIOR HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCS, CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DOCS, CEO
Authorized Official - Phone:906-630-0529
Mailing Address - Street 1:330 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-2340
Mailing Address - Country:US
Mailing Address - Phone:906-630-0529
Mailing Address - Fax:877-795-1376
Practice Address - Street 1:330 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-2340
Practice Address - Country:US
Practice Address - Phone:906-630-0529
Practice Address - Fax:877-795-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care