Provider Demographics
NPI:1821135245
Name:LAKESIDE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:LAKESIDE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEA SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-262-1724
Mailing Address - Street 1:2837 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8321
Mailing Address - Country:US
Mailing Address - Phone:501-262-1724
Mailing Address - Fax:501-262-6227
Practice Address - Street 1:2837 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8321
Practice Address - Country:US
Practice Address - Phone:501-262-1724
Practice Address - Fax:501-262-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)