Provider Demographics
NPI:1215073887
Name:LAKEWAY ACHIEVEMENT CENTER
Entity type:Organization
Organization Name:LAKEWAY ACHIEVEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-586-2196
Mailing Address - Street 1:320 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-1106
Mailing Address - Country:US
Mailing Address - Phone:423-586-2196
Mailing Address - Fax:423-317-8880
Practice Address - Street 1:320 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-1106
Practice Address - Country:US
Practice Address - Phone:423-586-2196
Practice Address - Fax:423-317-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities