Provider Demographics
NPI:1699047456
Name:LAKESIDE BEHAVIORAL SOLUTIONS
Entity type:Organization
Organization Name:LAKESIDE BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEOTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW//LCAC
Authorized Official - Phone:219-801-1789
Mailing Address - Street 1:1804EAST 142STREET
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3010
Mailing Address - Country:US
Mailing Address - Phone:219-801-1789
Mailing Address - Fax:219-354-0356
Practice Address - Street 1:5944 1/2 HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2424
Practice Address - Country:US
Practice Address - Phone:219-801-1789
Practice Address - Fax:219-354-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1636-0-ASOOtherFAMILY AND SOCIAL SERVICES ADMINISTRATION