Provider Demographics
NPI:1740673516
Name:THE LAKES TREATMENT CENTER
Entity type:Organization
Organization Name:THE LAKES TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CATTANEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-480-3397
Mailing Address - Street 1:7260 O'BYRNES FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:COPPEROPOLIS
Mailing Address - State:CA
Mailing Address - Zip Code:95228
Mailing Address - Country:US
Mailing Address - Phone:209-325-8506
Mailing Address - Fax:209-785-8200
Practice Address - Street 1:7260 OBYRNES FERRY RD
Practice Address - Street 2:
Practice Address - City:COPPEROPOLIS
Practice Address - State:CA
Practice Address - Zip Code:95228-9761
Practice Address - Country:US
Practice Address - Phone:209-325-8506
Practice Address - Fax:209-785-8200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LAKES TREATMENT CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-18
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050005AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility