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Organization
LAKESIDE RTF LLC
Active
Organization
LAKESIDE RTF LLC
Active
Parent organization
LAKESIDE OPCO INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKESIDE OPCO INC
Authorized official
MS. ELIZABETH CHOQUETTE (BOM)
(863) 773-2857
Entity
Organization
Contact information
Practice address
1962 VANDOLAH RD, WAUCHULA, FL 33873-8726
(863) 773-2857
Mailing address
1962 VANDOLAH RD, WAUCHULA, FL 33873-8726
(863) 773-2857
Taxonomy
Speciality
Code
Description
License number
State
283X00000X
Rehabilitation Hospital
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
320700000X
Physical Disabilities Residential Treatment Facility
—
NULL
Other
Enumeration date
10/05/2026
Last updated
10/05/2026
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