| Lakeside Clubhouse | |
|
490 Century Ln Holland MI 49423 | |
| (616) 965-8380 | |
| (616) 965-8381 |
| Full Name | Lakeside Clubhouse |
|---|---|
| Speciality | Social Worker |
| Location | 490 Century Ln, Holland, Michigan |
| Authorized Official Name and Position | Linda M Constantino (CFO) |
| Authorized Official Contact | 6167762128 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Clubhouse 100 Cherry St Se Grand Rapids MI 49503-4526 Ph: (616) 965-8200 | Lakeside Clubhouse 490 Century Ln Holland MI 49423 Ph: (616) 965-8380 |
| NPI Number | 1215414800 |
|---|---|
| Provider Enumeration Date | 07/26/2018 |
| Last Update Date | 07/30/2018 |
| Medicare PECOS PAC ID | 6800707647 |
|---|---|
| Medicare Enrollment ID | O20230111002446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215414800 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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