| NPI | 1215414800 |
|---|---|
| Doing Business As | LAKESIDE CLUBHOUSE |
| Entity Type | Organization |
| Authorized Contact | LINDA M CONSTANTINO CFO 616-776-2128 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2018-07-30 |