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Organization
LAKESIDE CRISIS STABILIZATION
Active
Organization
LAKESIDE CRISIS STABILIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES LI (RHA)
(912) 356-2011
Entity
Organization
Contact information
Practice address
600 DOT BARN RD, BLOOMINGDALE, GA 31302-9353
(912) 330-8335
(912) 330-8340
Mailing address
600 DOT BARN RD, BLOOMINGDALE, GA 31302-9353
(912) 330-8335
(912) 330-8340
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
GA
Other
Enumeration date
10/24/2006
Last updated
08/22/2020
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