Organization
LAKESIDE RESIDENTIAL CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN J BAGLEY (PRESIDENT)
(208) 790-4162
Entity
Organization
Contact information
Practice address
605 JOSEPH AVE, WINCHESTER, ID 83555-5034
(208) 790-4162
Mailing address
PO BOX 874, LEWISTON, ID 83501-0874
(208) 790-4162
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
04/15/2025
Last updated
04/15/2025
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