| NPI | 1134722820 |
|---|---|
| Doing Business As | LAKESIDE NEUROLOGIC |
| Entity Type | Organization |
| Authorized Contact | MANEESH BANSAL COO 800-697-5390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283X00000X Rehabilitation Hospital |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-11-17 |