Organization
LAKERIDGE CARE MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEMETRIA GAYLE WALLACE RN (DIRECTOR CASE MANAGEMENT PROGRAM)
18663868404
Entity
Organization
Contact information
Practice address
2635 VILLA DI LAGO UNIT 4, GRAND PRAIRIE, TX 75054-6630
(186) 638-6840
(866) 386-8404
Mailing address
2635 VILLA DI LAGO UNIT 4, GRAND PRAIRIE, TX 75054-6630
(186) 638-6840
(866) 386-8404
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
01/21/2016
Last updated
01/21/2016
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