Organization
LAKESIDE CLINIC, LLC
Active
Other names
MedMark Treatment Centers Clearwater
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE JARVIE (VP, TREASURER)
(214) 379-3300
Entity
Organization
Contact information
Practice address
13700 58TH ST N, BUILDING 2, SUITE 201, CLEARWATER, FL 33760-3757
(727) 223-3545
Mailing address
1720 LAKEPOINTE DR STE 117, LEWISVILLE, TX 75057-6425
(469) 470-4779
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
01/22/2016
Last updated
07/29/2024
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