Healthcare Provider Details

I. General information

NPI: 1740673516
Provider Name (Legal Business Name): THE LAKES TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7260 OBYRNES FERRY RD
COPPEROPOLIS CA
95228-9761
US

IV. Provider business mailing address

7260 O'BYRNES FERRY ROAD
COPPEROPOLIS CA
95228
US

V. Phone/Fax

Practice location:
  • Phone: 209-325-8506
  • Fax: 209-785-8200
Mailing address:
  • Phone: 209-325-8506
  • Fax: 209-785-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number050005AP
License Number StateCA

VIII. Authorized Official

Name: BERNADETTE CATTANEO
Title or Position: PRESIDENT
Credential:
Phone: 209-480-3397