| NPI | 1164697199 |
|---|---|
| Other Name | LAKESIDE DIVISION |
| Entity Type | Organization |
| Authorized Contact | HENRY CHARLES COX President / Administrator 951-727-4303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2008-04-30 |