Provider Demographics
NPI:1588299168
Name:LAKESIDE NEPA INC.
Entity type:Organization
Organization Name:LAKESIDE NEPA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROJECT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CONABOY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:570-814-0444
Mailing Address - Street 1:125 SCRANTON POCONO HWY
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2274
Mailing Address - Country:US
Mailing Address - Phone:570-344-5253
Mailing Address - Fax:
Practice Address - Street 1:125 SCRANTON POCONO HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2274
Practice Address - Country:US
Practice Address - Phone:570-344-5253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty