Healthcare Provider Details

I. General information

NPI: 1417020355
Provider Name (Legal Business Name): LAKESIDE RECOVERY CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10322 NE 132ND ST
KIRKLAND WA
98034
US

IV. Provider business mailing address

10322 NE 132ND ST
KIRKLAND WA
98034
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-3116
  • Fax: 425-823-3132
Mailing address:
  • Phone: 425-823-3116
  • Fax: 425-823-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CARLTON M KESTER
Title or Position: PRESIDENT
Credential:
Phone: 425-823-3116