| NPI | 1750618419 |
|---|---|
| Doing Business As | LAKESIDE ACADEMY |
| Entity Type | Organization |
| Authorized Contact | DON NITZ Board Administrator 269-381-4760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2009-11-17 |