Provider Demographics
NPI:1396046470
Name:LAKE REGION FURNITURE CO. INC.
Entity type:Organization
Organization Name:LAKE REGION FURNITURE CO. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-856-6711
Mailing Address - Street 1:673 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2624
Mailing Address - Country:US
Mailing Address - Phone:207-856-6711
Mailing Address - Fax:207-856-1315
Practice Address - Street 1:673 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-2624
Practice Address - Country:US
Practice Address - Phone:207-856-6711
Practice Address - Fax:207-856-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies