LAKE SHORE SUPPLY HME and Services Provider License verification

Business Entity

NOT RENEWED

License Type

HME and Services Provider

Description

HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER

License Number

203000317

License Status

NOT RENEWED

Business

Business Name

LAKE SHORE SUPPLY

Original Issue Date

09/26/2001

Effective Date

04/30/2003

Expiration Date

03/31/2003

City

CHICAGO

State

Zip

60618

County

COOK

Ever Disciplined

LastModifiedDate

09/11/2005