OrganizationActive
Lakeside Life Recovery, LLC
NPI 1609171008 · Substance Abuse Rehabilitation Facility · Newark, TX
Provider details
- NPI number
- 1609171008
- Entity type
- Organization
- Primary specialty
- Substance Abuse Rehabilitation FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Don Johnson, Executive Director(972) 754-6257
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Detailed profile(82/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
341 County Road 4874
Newark, TX 76071-3715
Phone: (817) 831-4673
Street-level locationGet directions
Mailing address
2909 Race St
Fort Worth, TX 76111-4134
Registry dates
- Enumerated
- 2011-01-14
- Last updated
- 2011-01-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.