THE LAKES AT BLACK CREEK (NPI# 1427582725) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427582725 |
| Entity Type | Organization |
| Organization Name | THE LAKES AT BLACK CREEK |
| Practice Address |
88 Sanguinetti Ct Copperopolis CA 95228-9459 |
| Mailing Address |
7260 Obyrnes Ferry Rd Copperopolis CA 95228-9761 |
| Practice Telephone | 2093258506 |
| Mailing Telephone | 2093258535 |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2017-11-09 |
| Authorized Official Name | NICHOLAS J MCNULTY (COMPLIANCE DIRECTOR) |
| Authorized Official Telephone | 2097685871 |
| Is Organization Subpart | Y |
| Parent Organization Name | THE LAKES TREATMENT CENTER INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 050005BP | CA | Residential Treatment Facilities |
| Street Address |
88 SANGUINETTI CT |
| City | COPPEROPOLIS |
| State | CA |
| Zip Code | 95228-9459 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487986519 | Emotional and Behavioral Helath Services | Clinic/Center | 1165 Ranch Rd, Copperopolis, CA 95228 | 2010-01-29 |
| 1760610497 | Sofia R. Bulahan | Nurse Practitioner | Copperopolis Family Medical Clinic, 3505 Spangler Lane, Suite 400, Copperopolis, CA 95228 | 2009-07-01 |
| 1093140238 | Kevin S Tom | Pharmacy | 49 Cosmic Ct Ste C, Copperopolis, CA 95228-9300 | 2013-09-06 |
| 1164529459 | Copperopolis Pharmacy | Pharmacy | 49 Cosmic Ct, Suite C, Copperopolis, CA 95228-9300 | 2006-09-20 |
| 1891975108 | Mark Scott Demanes | Marriage & Family Therapist | 120 Athena Dr, Copperopolis, CA 95228-9329 | 2007-11-05 |
| 1083636328 | Richard Wesley French | Dentist | 90 Copper Cove Dr Ste A, Copperopolis, CA 95228-9373 | 2006-07-24 |
| 1750886651 | Kirandeep Kaur Dds Inc | Clinic/Center | 90 Copper Cove Dr Ste A, Copperopolis, CA 95228-9373 | 2018-03-24 |
| 1073878021 | Kirandeep Kaur | Dentist | 90 Copper Cove Dr Ste A, Copperopolis, CA 95228-9373 | 2012-07-05 |
| 1538622162 | Ocean Reid Grohman | Specialist/Technologist | 20 Vista Knolls Ct, Copperopolis, CA 95228-9475 | 2019-04-10 |
| 1588725196 | Mark Twain Medical Center | Clinic/Center | 3505 Spangler Ln, Suite 400, Copperopolis, CA 95228-9583 | 2006-12-13 |
| Find all providers in zip 95228 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740673516 | The Lakes Treatment Center | Substance Abuse Rehabilitation Facility | 7260 Obyrnes Ferry Rd, Copperopolis, CA 95228-9761 | 2015-03-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497359 | California Care Detox & Treatment | Substance Abuse Rehabilitation Facility | 25542 Dana Mesa Dr, San Juan Capistrano, CA 92675-4311 | 2020-11-02 |
| 1952900797 | A Sacred Path | Substance Abuse Rehabilitation Facility | 5671 Spanish Flat Rd, Garden Valley, CA 95633 | 2020-10-22 |
| 1467051672 | Spearhead Health Centers, LLC. | Substance Abuse Rehabilitation Facility | 11704 Wilshire Blvd Ste 226, Los Angeles, CA 90025-1504 | 2020-10-19 |
| 1073111613 | A Place To Heal | Substance Abuse Rehabilitation Facility | 14540 Hamlin St Ste H, Van Nuys, CA 91411-4153 | 2020-10-15 |
| 1871191569 | Old Oak Ranch Recovery Center | Substance Abuse Rehabilitation Facility | 19401 Susan Way, Sonora, CA 95370-9266 | 2020-10-14 |
| 1962009845 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 9952 Grandview Dr, La Mesa, CA 91941-6874 | 2020-10-05 |
| 1376140384 | Magic House Recovery Inc | Substance Abuse Rehabilitation Facility | 1001 S Mountvale Ct, Anaheim, CA 92808-2108 | 2020-10-02 |
| 1942807060 | New Perceptions North, LLC | Substance Abuse Rehabilitation Facility | 5084 N Fruit Ave Ste 105, Fresno, CA 93711-3000 | 2020-10-01 |
| 1346857679 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 3480 Hidden Trail Dr, Jamul, CA 91935-2104 | 2020-09-30 |
| 1992312227 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 2810 Camino Del Rio S Ste 106, San Diego, CA 92108-3819 | 2020-09-30 |
| Find all providers with the same taxonomy | ||||
| City | COPPEROPOLIS |
| Zip Code | 95228 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.