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General NPI Number Information
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NPI Number | 1629587308
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Entity Type | Organization
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Legal Business Name | THE LAKES ARLINGTON
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 2720 ARLINGTON DR
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City | HOLLISTER
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State | CA
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Zip | 95023-4300
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Country | US
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Telephone | 209-325-8506
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Fax |
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Provider Business Mailing Address
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Address Line | 7260 OBYRNES FERRY RD
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City | COPPEROPOLIS
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State | CA
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Zip | 95228-9761
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Country | US
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Telephone | 209-325-8506
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE DIRECTOR
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Name | NICHOLAS MCNULTY
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Credential |
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Telephone | 209-768-5871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 350003AP
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License Number State | CA
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