SOBRIETY SOLUTIONS LAKESIDE LLC NPI 1639682438

NPI Information

NPI: 1639682438
Provider Name: SOBRIETY SOLUTIONS LAKESIDE LLC
Classification: Clinic/Center - 261QR0405X
Specialization: Rehabilitation, Substance Use Disorder
Entity Type: Organization
Doing Business As: LAKESIDE RECOVERY CENTER
CLIA Number: 31D2148743
Address: 900 LIBERTY PL
SICKLERVILLE, NJ
ZIP 08081
Phone: (856) 302-1362

Map and Directions

Get Directions

NPI Details

SOBRIETY SOLUTIONS LAKESIDE LLC is a rehabilitation and substance use disorder clinic center in Sicklerville, NJ. SOBRIETY SOLUTIONS LAKESIDE LLC NPI is 1639682438. The provider is registered as an organization entity type.
The provider Is Doing Business As Lakeside Recovery Center.

The provider's business location address is:

900 LIBERTY PL
SICKLERVILLE, NJ
ZIP 08081-716
Phone: (856) 302-1362

The provider's authorized official is Larry Pettis .
The authorized official title is Medical Director and has the following contact phone number (856) 302-1362.

The CLIA number assigned to this NPI record is 31D2148743 - other - substance abuse with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/15/2017 and was last updated on 7/31/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	2000667	NEW JERSEY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2000667	OTHER	NEW JERSEY	STATE OF NJ

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI

Next NPI