Organization
LAKERIDGE VILLAGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENIA HOLIMON (CHIEF OF STAFF)
(313) 340-2808
Entity
Organization
Contact information
Practice address
15941 FAIRFIELD ST, DETROIT, MI 48238-4123
(313) 345-4310
(313) 345-4315
Mailing address
15025 FENKELL ST, DETROIT, MI 48227-2647
(313) 345-4310
(313) 345-4315
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
822985
MI
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
02/10/2009
Last updated
01/26/2026
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