SOBRIETY SOLUTIONS LAKESIDE LLC (NPI# 1639682438) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639682438 |
| Entity Type | Organization |
| Organization Name | SOBRIETY SOLUTIONS LAKESIDE LLC |
| Other Organization Name | LAKESIDE RECOVERY CENTER |
| Practice Address |
200 Independence Blvd Sicklerville NJ 08081-1092 |
| Practice Telephone | 8563021362 |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | LARRY PETTIS (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8563021362 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
2000667 | NJ | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | STATE OF NJ | 2000667 | 01 |
| Other Name | Type Code |
|---|---|
| Lakeside Recovery Center | Doing Business As Name - Organization |
| Street Address |
200 INDEPENDENCE BLVD |
| City | SICKLERVILLE |
| State | NJ |
| Zip Code | 08081-1092 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750651568 | Lakeside Recovery Center | Clinic/Center | 200 Independence Blvd, Sicklerville, NJ 08081-1092 | 2012-01-10 |
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|---|---|---|---|---|
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| 1164901351 | Devereux Foundation | Day Training, Developmentally Disabled Services | 1601 - 1603 Sicklerville Road, Sicklerville, NJ 08081 | 2018-08-09 |
| 1467930990 | Brooke Schatzman | Lactation Consultant, Non-RN | 112 Hampton Court, Sicklerville, NJ 08081 | 2018-08-06 |
| 1831686443 | Grandular Senior Living | Day Training/Habilitation Specialist | 542 Berlin Cross Key Road Ste 3-270, Sicklerville, NJ 08081 | 2018-04-18 |
| 1942718465 | Community Dental of Sicklerville, P.C. | Dentist | 513 Cross Keys Road, Sicklerville, NJ 08081 | 2018-01-18 |
| 1831609304 | Assoc. for Retarded Citizens, Inc. Gloucester County | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10 Brandon Court, Sicklerville, NJ 08081 | 2017-10-10 |
| 1710402631 | Premiere Behavioral Supports | Behavior Technician | 404 Independence Blvd, Sicklerville, NJ 08081 | 2017-08-11 |
| 1285167346 | A Better Concept | Community/Behavioral Health | 20 Wildcat Branch Dr, Sicklerville, NJ 08081 | 2017-04-06 |
| 1558712299 | Shaquira Briggs | Counselor | 40 Vernon Court, Sicklerville, NJ 08081 | 2016-06-23 |
| 1588012496 | Grace Musokae | Pharmacist | 412 Sicklerville Rd, Jolin's Pharmacy #103, Sicklerville, NJ 08081 | 2016-06-01 |
| Find all providers in zip 08081 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| 1487253779 | Integrity, Inc | Clinic/Center | 1091-1093 Broad Street, Newark, NJ 07102 | 2020-10-19 |
| 1437764354 | Phoenix Behavioral Health LLC | Clinic/Center | 102 Browning Ln Ste 2, Cherry Hill, NJ 08003-3195 | 2020-09-09 |
| 1710504881 | Vimax LLC | Clinic/Center | 6 Cornwall Ct, East Brunswick, NJ 08816-3347 | 2020-07-06 |
| 1588289615 | Camden County Suboxone LLC | Clinic/Center | 8 Somerdale Sq, Somerdale, NJ 08083-1345 | 2020-06-15 |
| 1558905380 | Grace Community Development Center | Clinic/Center | 100 Melville Ln, Willingboro, NJ 08046-2912 | 2019-11-05 |
| 1740822121 | The Empowerment House, Non Profit Inc. | Clinic/Center | 1314 S Clinton Ave, Trenton, NJ 08611-1436 | 2019-10-17 |
| 1265088892 | Absolute Awakenings Treatment Center LLC | Clinic/Center | 3000 Route 10 West, Denville, NJ 07834 | 2019-08-09 |
| 1326607243 | Recovery Zone Solutions, LLC | Clinic/Center | 124 East Main Street, Ste#109, Denville, NJ 07834 | 2019-06-13 |
| 1720644800 | Ars Treatment Centers of New Jersey, PC | Clinic/Center | 4 Murray Grove Ln, Lanoka Harbor, NJ 08734-2837 | 2019-05-14 |
| 1184182230 | Turning Point, Inc. | Clinic/Center | 101 Prospect St Ste 210, Lakewood, NJ 08701-5003 | 2019-03-07 |
| Find all providers with the same taxonomy | ||||
| City | SICKLERVILLE |
| Zip Code | 08081 |
Please comment or provide details below to improve the information on SOBRIETY SOLUTIONS LAKESIDE LLC.
| 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.