LAKESIDE LIFE RECOVERY LLC NPI 1609171008

NPI Information

NPI: 1609171008
Provider Name: LAKESIDE LIFE RECOVERY, LLC
Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization
Address:
341 COUNTY ROAD 4874
NEWARK, TX
ZIP 76071
Phone: (817) 831-4673
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LAKESIDE LIFE RECOVERY, LLC is a substance abuse rehabilitation facility in Newark, TX. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. LAKESIDE LIFE RECOVERY, LLC NPI is 1609171008. The provider is registered as an organization entity type.

The provider's business location address is:

341 COUNTY ROAD 4874
NEWARK, TX
ZIP 76071-715
Phone: (817) 831-4673

The provider's authorized official is Don Perry Johnson .
The authorized official title is Executive Director and has the following contact phone number (972) 754-6257.

The enumeration date for this NPI number is 1/14/2011 and was last updated on 1/14/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	324500000X	Substance Abuse Rehabilitation Facility				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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