Lakeside RTF LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

LAKESIDE RTF LLC

Practice address

1962 Vandolah Rd
Wauchula, FL 33873-8726

Phone

(863) 773-2857

NPI assigned

Oct 5, 2026

Last updated

Oct 5, 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) 773-2857

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1791158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791158400000",
    "number": "1841194750",
    "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": [
        {
            "address_1": "1044 S Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Wauchula",
            "state": "FL",
            "postal_code": "338733412",
            "country_code": "US",
            "telephone_number": "863-773-2857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESIDE RTF LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKESIDE OPCO INC",
        "enumeration_date": "2026-10-05",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A",
        "authorized_official_last_name": "CHOQUETTE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "BOM",
        "authorized_official_telephone_number": "863-773-2857",
        "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": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wajahat Ullah Khan, MD
• Kenneth Wayne Kilgore, D.C.
• Carrie Knight, PT
• Evan Mae Llupar Lachica
• Lakeside RTC LLC (Lakeside Neurologic)
• Lakeside SNF LLC
• Lakeside TLF, LLC (Lakeside Neurologic)
• Richard Leandro
• Larry Liedke
• Yanitt Grisel Lozada Perez, M.D.

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Wauchula, FL
• Providers in Wauchula, FL by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.