| NPI | 1508303124 |
|---|---|
| Doing Business As | LAKESIDE SCHOOL |
| Entity Type | Organization |
| Authorized Contact | GARY ALLAN NICHOLS Executive Director 870-538-5414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2022-08-30 |