Provider Demographics
NPI:1548649239
Name:LAKETOP INC.
Entity type:Organization
Organization Name:LAKETOP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJIBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGEDENGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-960-0048
Mailing Address - Street 1:900 RIDGE RD
Mailing Address - Street 2:SUITE 3NW
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 RIDGE RD
Practice Address - Street 2:SUITE 3NW
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1933
Practice Address - Country:US
Practice Address - Phone:708-960-0048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
IL3001172253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care