| NPI | 1013986082 |
|---|---|
| Doing Business As | NB - LAKE RESIDENTIAL SUPPORT CSN |
| Entity Type | Organization |
| Authorized Contact | TONYA MARIE FASONE Fiscal Manager 614-466-9930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2011-11-30 |