Lakeridge Care Management

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

LAKERIDGE CARE MANAGEMENT

Practice address

2635 Villa Di Lago Unit 4
Grand Prairie, TX 75054-6630

Phone

(186) 638-6840

Fax

(866) 386-8404

NPI assigned

Jan 21, 2016

Last updated

Jan 21, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Demetria Gayle Wallace, RNNPI 1710344635

Title

Director Case Management Program

Phone

(866) 386-8404

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Demetria Wallace, RN

  • Case Manager/Care Coordinator
  • Grand Prairie, TX
  • NPI 1710344635
  NPD (past) Authorized official

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

{
    "created_epoch": "1453334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453334400000",
    "number": "1659738623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 VILLA DI LAGO UNIT 4",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750546630",
            "telephone_number": "186-638-6840",
            "fax_number": "866-386-8404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 VILLA DI LAGO UNIT 4",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750546630",
            "telephone_number": "186-638-6840",
            "fax_number": "866-386-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKERIDGE CARE MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-21",
        "last_updated": "2016-01-21",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "DEMETRIA",
        "authorized_official_middle_name": "GAYLE",
        "authorized_official_title_or_position": "DIRECTOR CASE MANAGEMENT PROGRAM",
        "authorized_official_telephone_number": "18663868404",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lavica Lane, LM, CPM

• Case Management Agency in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Case Management Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; 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.