LAKESIDE LIFE RECOVERY, LLC (NPI# 1609171008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609171008 |
| Entity Type | Organization |
| Organization Name | LAKESIDE LIFE RECOVERY, LLC |
| Practice Address |
341 County Road 4874 Newark TX 76071-3715 |
| Mailing Address |
2909 Race St Fort Worth TX 76111-4134 |
| Practice Telephone | 8178314673 |
| Mailing Telephone | 8178314673 |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2011-01-14 |
| Authorized Official Name | MR. DON PERRY JOHNSON SR. (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9727546257 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Street Address |
341 COUNTY ROAD 4874 |
| City | NEWARK |
| State | TX |
| Zip Code | 76071-3715 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669013413 | Kimberly Fleischer | Counselor | 519 Post Oak Dr, Newark, TX 76071-3141 | 2019-10-03 |
| 1538725767 | Kimberly Akerstrom | Massage Therapist | 503 Wise St, Newark, TX 76071-3828 | 2019-05-13 |
| 1114586799 | Robert Tonti | Chiropractor | 3017 Fm 718, Newark, TX 76071-4001 | 2019-06-07 |
| 1689212870 | Mandikala Ikota | Licensed Vocational Nurse | 146 Cattlemans Creek Rd, Newark, TX 76071-4327 | 2019-12-18 |
| 1285289223 | Jessica Dawn Seidel | Counselor | 106 Watering Hole, Newark, TX 76071-4333 | 2019-08-06 |
| 1760962096 | Healthworks Med Group of Texas Darlington P A | Clinic/Center | 14355 Morris Dido Rd, Newark, TX 76071-9501 | 2018-08-16 |
| 1376006395 | Wecare Tlc- Kenneth Copeland Ministries | Clinic/Center | 14355 Morris Dido Rd, Newark, TX 76071-9501 | 2019-04-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700487709 | Shannon Paige Bailey | Registered Nurse | 719 Elkton Rd, Newark, DE 19711-4919 | 2020-11-05 |
| 1003417288 | Ariane Monique Chua Dequina | Registered Nurse | 340 Airis Drive, Newark, NJ 07114 | 2020-11-04 |
| 1861093270 | Ocean Klein | Homemaker | 180 Hilltop Dr Ne, Newark, OH 43055-8942 | 2020-11-03 |
| 1902407497 | Brooke Ashley Sforza | Nurse Practitioner | 7518 Linnville Rd, Newark, OH 43056-9340 | 2020-11-03 |
| 1699376129 | Star Medcare PC | Physical Medicine & Rehabilitation | 62 Elizabeth Ave., Newark, NJ 07108 | 2020-11-02 |
| 1013517747 | Guardian Angel Home Health Care Agency, LLC | Home Health Aide | 30 Prestbury Sq Ste 301, Newark, DE 19713-3235 | 2020-10-30 |
| 1528668431 | Newark Resident Homes | In Home Supportive Care | 175 S Williams St, Newark, OH 43055-3968 | 2020-10-29 |
| 1437759412 | Teresa Smoke | Homemaker | 2003 Lundys Ln, Newark, OH 43055-9543 | 2020-10-28 |
| 1710587902 | Stephanie Prather | Clinical Exercise Physiologist | 24 Celestial Way, Newark, DE 19711-1914 | 2020-10-28 |
| 1457951717 | Christa Ware | Homemaker | 610 Seneca Dr, Newark, OH 43055-3767 | 2020-10-27 |
| Find all providers in NEWARK | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467051367 | Elev8 Centers of New Jersey | Substance Abuse Rehabilitation Facility | 20 Toler Pl, Newark, NJ 07114-1431 | 2020-10-21 |
| 1548736838 | Integrity, Inc | Substance Abuse Rehabilitation Facility | 101 Lincoln Park, 2nd Floor, Newark, NJ 07102 | 2018-10-15 |
| 1285118679 | A Center for Mental Wellness Community Support Programs, LLC | Substance Abuse Rehabilitation Facility | 25 S. Old Baltimore Pike, Lafayette Building 1, Suite 201, Newark, DE 19702 | 2018-09-20 |
| 1396249264 | Integrity, Inc | Substance Abuse Rehabilitation Facility | 49 Lincoln Park, Newark, NJ 07102 | 2018-03-23 |
| 1578074357 | Integrity, Inc | Substance Abuse Rehabilitation Facility | 37 Lincoln Park, Newark, NJ 07102-2390 | 2017-10-19 |
| 1497266266 | Integrity, Inc | Substance Abuse Rehabilitation Facility | 99 Lincoln Park, Newark, NJ 07102-2388 | 2017-10-19 |
| 1548771892 | Integrity, Inc | Substance Abuse Rehabilitation Facility | 105 Lincoln Park, Newark, NJ 07102-2388 | 2017-10-13 |
| 1609320258 | Comunidad Unida Para La Rehabilitacion De Adictos | Substance Abuse Rehabilitation Facility | 75 Lincoln Park, Newark, NJ 07102-2303 | 2016-08-12 |
| 1699123729 | Comunidad Unida Para La Rehabilitacion De Adictos | Substance Abuse Rehabilitation Facility | 61 Lincoln Park, Newark, NJ 07102-2390 | 2016-05-31 |
| 1346634714 | Angel Hope House | Substance Abuse Rehabilitation Facility | 800 Clinton Ave, Newark, NJ 07108-1004 | 2015-03-24 |
| Find all providers in NEWARK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.