NPIMap

Organization Active NPI

Lakeside Crisis Stabilization

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Bloomingdale, GA
National Provider Identifier
1598848277
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
LAKESIDE CRISIS STABILIZATION
Practice address
600 Dot Barn Rd
Bloomingdale, GA 31302-9353
Phone
(912) 330-8335
Fax
(912) 330-8340
NPI assigned
Oct 24, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Charles Li
Title
Rha
Phone
(912) 356-2011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X GA Primary

Addresses

Primary practice location

600 Dot Barn Rd
Bloomingdale, GA 31302-9353

Mailing address

600 Dot Barn Rd
Bloomingdale, GA 31302-9353
Phone (912) 330-8335

National Provider Directory

National Provider Directory
Tax ID family
Ga Department of Behavioral Health and Developmental Disabilities74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598848277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 DOT BARN RD",
            "city": "BLOOMINGDALE",
            "state": "GA",
            "postal_code": "313029353",
            "telephone_number": "912-330-8335",
            "fax_number": "912-330-8340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 DOT BARN RD",
            "city": "BLOOMINGDALE",
            "state": "GA",
            "postal_code": "313029353",
            "telephone_number": "912-330-8335",
            "fax_number": "912-330-8340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE CRISIS STABILIZATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "RHA",
        "authorized_official_telephone_number": "912-356-2011"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomingdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.