Provider Demographics
NPI:1639555782
Name:LAKESIDE HEALTHCARE
Entity Type:Organization
Organization Name:LAKESIDE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-335-3954
Mailing Address - Street 1:1530 SSW LOOP 323
Mailing Address - Street 2:SUITE 116
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2562
Mailing Address - Country:US
Mailing Address - Phone:903-335-3954
Mailing Address - Fax:
Practice Address - Street 1:1530 SSW LOOP 323
Practice Address - Street 2:SUITE 116
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2562
Practice Address - Country:US
Practice Address - Phone:903-335-3954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based