Organization
SOBRIETY SOLUTIONS LAKESIDE LLC
Active
Other names
Lakeside Recovery Center
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY PETTIS MD (MEDICAL DIRECTOR)
(856) 302-1362
Entity
Organization
Contact information
Practice address
900 LIBERTY PL, SICKLERVILLE, NJ 08081-5716
(856) 302-1362
Mailing address
200 INDEPENDENCE BLVD, SICKLERVILLE, NJ 08081-1092
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
2000667
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000667
STATE OF NJ
NJ
Enumeration date
11/15/2017
Last updated
07/31/2023
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