Organization
LAKESIDE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICH SWINGER (TREATMENT DIRECTOR)
(314) 434-4535
Entity
Organization
Contact information
Practice address
13044 MARINE AVE, SAINT LOUIS, MO 63146-2118
(314) 434-4535
(314) 434-9157
Mailing address
13044 MARINE AVE, SAINT LOUIS, MO 63146-2118
(314) 434-4535
(314) 434-9157
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
08/11/2008
Last updated
08/11/2008
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