Reliant Lakeside Holdings LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

RELIANT LAKESIDE HOLDINGS LLC

Practice address

RR 4 Box 357
Dallas, PA 18612-9236

Phone

(570) 639-1885

NPI assigned

Apr 18, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marc Myzal

Title

Coo

Phone

(215) 558-3700

Specialties & licenses 1

Addresses

Other names 1

• Lakeside Health and Rehabilitation Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1124385000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 ISLAND AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191533228",
            "telephone_number": "215-558-3700",
            "fax_number": "215-558-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 4 BOX 357",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186129236",
            "telephone_number": "570-639-1885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELIANT LAKESIDE HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-18",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "MYZAL",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "215-558-3700"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kaitlin Cecilia Redling, PT, DPT
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• Judi Maura Rencavage
• Amanda Christine Riedinger, PHARMD
• Katlyn Marie Rincavage, OTR/L
• Briget Rischawy, OTR/L
• Amy Lynn Roccograndi, LSW

• Skilled Nursing Facility in Dallas, PA
• Providers in Dallas, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.