Organization
LAKESIDE CSU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE SIMPSON (BILLING MANAGER)
(912) 449-7109
Entity
Organization
Contact information
Practice address
600 DOT BARN RD, BLOOMINGDALE, GA 31302-9353
(912) 449-7109
Mailing address
600 DOT BARN RD, BLOOMINGDALE, GA 31302-9353
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/27/2016
Last updated
01/27/2016
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