Lakeside RTC LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

LAKESIDE RTC LLC

Doing business as

Lakeside Neurologic

Practice address

1962 Vandolah Rd
Wauchula, FL 33873-8726

Phone

(863) 773-2857

NPI assigned

Aug 27, 2026

Last updated

Aug 28, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

LAKESIDE OPCO INCAs reported in NPPES

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

Authorized official

Name

Ms. Elizabeth Choquette

Title

Bom

Phone

(863) 451-6632

Specialties & licenses 4

Addresses

Other names 1

• LAKESIDE NEUROLOGIC Doing business as

Locations

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

{
    "created_epoch": "1787788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787875200000",
    "number": "1811804362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1962 VANDOLAH RD",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338738726",
            "telephone_number": "863-773-2857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1962 VANDOLAH RD",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338738726",
            "telephone_number": "863-773-2857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE RTC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKESIDE OPCO INC",
        "enumeration_date": "2026-08-27",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A",
        "authorized_official_last_name": "CHOQUETTE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "BOM",
        "authorized_official_telephone_number": "863-451-6632",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKESIDE NEUROLOGIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Magdy Ayad Kaldas, MD
• Wajahat Ullah Khan, MD
• Kenneth Wayne Kilgore, D.C.
• Carrie Knight, PT
• Evan Mae Llupar Lachica
• Lakeside RTF LLC
• Lakeside SNF LLC
• Lakeside TLF, LLC (Lakeside Neurologic)
• Richard Leandro
• Larry Liedke

• Emotionally Disturbed Childrens' Residential Treatment Facility in Wauchula, FL
• Providers in Wauchula, FL by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2026; 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.