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General NPI Number Information
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NPI Number | 1740673516
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Entity Type | Organization
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Legal Business Name | THE LAKES TREATMENT CENTER
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 11/09/2017
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Provider Practice Location 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 | 209-785-8200
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Provider Business Mailing Address
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Address Line | 7260 O'BYRNES FERRY ROAD
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City | COPPEROPOLIS
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State | CA
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Zip | 95228
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Country | US
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Telephone | 209-325-8506
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Fax | 209-785-8200
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Authorized Official
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Title or Position | PRESIDENT
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Name | BERNADETTE CATTANEO
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Credential |
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Telephone | 209-480-3397
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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 | 050005AP
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License Number State | CA
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