# RELIANT LAKESIDE HOLDINGS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeside Health and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124385000
- **Authorized official:** MARC MYZAL (COO)
- **Authorized official phone:** (215) 558-3700

## Contact information

- **Practice address:** RR 4 BOX 357, DALLAS, PA 18612-9236
- **Practice address phone:** (570) 639-1885
- **Mailing address:** 3601 ISLAND AVE, PHILADELPHIA, PA 19153-3228
- **Mailing address phone:** (215) 558-3700
- **Mailing address fax:** (215) 558-3701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 04/18/2012
- **Last updated:** 04/18/2012