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Organization

LAKESIDE FOR CHILDREN

Active
Other names
Lakeside Academy
Organization subpart
No

Provider details

NPI number
Authorized official
DON NITZ (BOARD ADMINISTRATOR)
(269) 381-4760
Entity
Organization

Contact information

Practice address
3921 OAKLAND DR, KALAMAZOO, MI 49008-4819
(269) 381-4760
Mailing address
3921 OAKLAND DR, KALAMAZOO, MI 49008-4819
(269) 381-4760

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6357061
STATE OF MICHIGAN RESIDENTIAL PROVIDER NUMBER
MI
Enumeration date
11/17/2009
Last updated
11/17/2009
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