| NPI | 1639682438 |
|---|---|
| Doing Business As | LAKESIDE RECOVERY CENTER |
| Entity Type | Organization |
| Authorized Contact | LARRY PETTIS Medical Director 856-302-1362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: NJ 2000667) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2023-07-31 |