Provider Demographics
NPI:1922801166
Name:ADAMS, LASSIDERE
Entity type:Individual
Prefix:
First Name:LASSIDERE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 RIDGECREST CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-2414
Mailing Address - Country:US
Mailing Address - Phone:810-644-6969
Mailing Address - Fax:
Practice Address - Street 1:621 W YORK AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-2031
Practice Address - Country:US
Practice Address - Phone:810-644-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health