| NPI | 1922652296 |
|---|---|
| Doing Business As | THE LAKE IOP |
| Entity Type | Organization |
| Authorized Contact | AMY CRICHTON Executive Director 760-200-3839 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2019-07-25 |