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General NPI Number Information
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NPI Number | 1750618419
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Entity Type | Organization
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Legal Business Name | LAKESIDE FOR CHILDREN
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 3921 OAKLAND DR
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City | KALAMAZOO
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State | MI
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Zip | 49008-4819
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Country | US
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Telephone | 269-381-4760
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Fax |
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Provider Business Mailing Address
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Address Line | 3921 OAKLAND DR
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City | KALAMAZOO
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State | MI
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Zip | 49008-4819
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Country | US
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Telephone | 269-381-4760
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Fax |
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Authorized Official
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Title or Position | BOARD ADMINISTRATOR
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Name | DON NITZ
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Credential |
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Telephone | 269-381-4760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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