Organization
LAKESIDE MEMORIAL HOSPITAL INC.
Active
Parent organization
LAKESIDE MEMORIAL HOSPITAL INC.
Other names
Family Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKESIDE MEMORIAL HOSPITAL INC.
Authorized official
MICHAEL STAPLETON (CEO)
(585) 395-6095
Entity
Organization
Contact information
Practice address
80 WEST AVE, SUITE 209, BROCKPORT, NY 14420-1322
(585) 637-6044
(585) 637-6053
Mailing address
80 WEST AVE, SUITE 209, BROCKPORT, NY 14420-1322
(585) 637-6044
(585) 637-6053
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00279543
—
NY
01
—
14005907
EXCELLUS-OUTPATIENT
NY
01
—
PC103050AX
PREFERRED CARE
NY
Enumeration date
05/07/2007
Last updated
07/14/2010
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