| NPI | 1578756334 |
|---|---|
| Doing Business As | LAKE PARK |
| Entity Type | Organization |
| Authorized Contact | MIRIAM COSEY Administrator 520-262-5583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2014-03-14 |