Healthcare Provider Details

I. General information

NPI: 1053249649
Provider Name (Legal Business Name): LAKESIDE HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9533 OTCHIPWE AVE N
STILLWATER MN
55082-8511
US

IV. Provider business mailing address

30310 RANCHO VIEJO RD
SAN JUAN CAPISTRANO CA
92675-1576
US

V. Phone/Fax

Practice location:
  • Phone: 833-589-5150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY FARBMAN
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 949-301-2863