Organization
LAKE PARK GROUP, LLC
Active
Other names
Lake Park
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM COSEY (ADMINISTRATOR)
(520) 262-5583
Entity
Organization
Contact information
Practice address
2114 W GRANT RD, 24, TUCSON, AZ 85745-1141
(520) 365-2025
(520) 365-2027
Mailing address
2114 W GRANT RD, 24, TUCSON, AZ 85745-1141
(520) 365-2025
(520) 365-2027
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
AZ
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/23/2007
Last updated
03/14/2014
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