Provider Demographics
NPI:1134292501
Name:LAKESIDE RECOVERY CENTERS INC
Entity Type:Organization
Organization Name:LAKESIDE RECOVERY CENTERS INC
Other - Org Name:LAKESIDE MILAM RECOVERY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:KESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-823-3116
Mailing Address - Street 1:10322 NE132ND ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-823-3116
Mailing Address - Fax:425-823-3132
Practice Address - Street 1:12845 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146
Practice Address - Country:US
Practice Address - Phone:206-241-0890
Practice Address - Fax:206-241-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children