LAKERIDGE VILLAGE, INC. (NPI# 1144469461) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144469461 |
| Entity Type | Organization |
| Organization Name | LAKERIDGE VILLAGE, INC. |
| Practice Address |
15941 Fairfield St Detroit MI 48238-4123 |
| Practice Telephone | 3133454310 |
| Practice Fax Number | 3133454315 |
| Mailing Telephone | 3133454310 |
| Mailing Fax Number | 3133454315 |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2020-10-06 |
| Authorized Official Name | MR. EDDIE C WILLIAMS JR. (CEO) |
| Authorized Official Telephone | 3133454310 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 822985 | MI | Residential Treatment Facilities |
| Street Address |
15941 FAIRFIELD ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48238-4123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134739501 | Lakeridge Village, Inc | Substance Abuse Rehabilitation Facility | 15941 Fairfield St, Detroit, MI 48238-4123 | 2020-07-31 |
| 1548886732 | Eugenia Holimon | Counselor | 15941 Fairfield St, Detroit, MI 48238-4123 | 2020-06-23 |
| 1790301992 | Gayle Lowe | Counselor | 15941 Fairfield St, Detroit, MI 48238-4123 | 2020-06-23 |
| 1134745995 | Juanita Charleston | Contractor | 15941 Fairfield St, Detroit, MI 48238-4123 | 2020-06-17 |
| 1023574787 | Kenneth Fultz | Peer Specialist | 15941 Fairfield St, Detroit, MI 48238-4123 | 2019-02-18 |
| 1023587359 | Megan E Doyle | Peer Specialist | 15941 Fairfield St, Detroit, MI 48238-4123 | 2018-11-15 |
| 1104309509 | Jonathon Edward Williams | Counselor | 15941 Fairfield St, Detroit, MI 48238-4123 | 2018-09-11 |
| 1487130555 | Rodney Johnson | Peer Specialist | 15941 Fairfield St, Detroit, MI 48238-4123 | 2018-07-12 |
| 1255817458 | Gina Smith | Peer Specialist | 15941 Fairfield St, Detroit, MI 48238-4123 | 2018-07-11 |
| 1275047797 | Terrence Edward Jones | Peer Specialist | 15941 Fairfield St, Detroit, MI 48238-4123 | 2017-11-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700372224 | Cardinal Home Healthcare Group, LLC | Home Health | 3165 Oakman Boulvard, Detroit, MI 48238 | 2018-07-09 |
| 1063963684 | Lydia Adkins | Counselor | 13505 Lasalle St, Apt 305, Detroit, MI 48238 | 2016-10-19 |
| 1750837324 | A Plus Care Transportation LLC | Clinic/Center | 14586 Wisconsin, Detroit, MI 48238 | 2016-09-01 |
| 1518413756 | Valarie Grayer - Felton | Case Manager/Care Coordinator | 15941 Fairfield St., Detroit, MI 48238 | 2016-08-28 |
| 1144773722 | Juanna Cherise Hardaway | Case Manager/Care Coordinator | 1935 Pasadena, Detroit, MI 48238 | 2016-07-29 |
| 1336503556 | Gladys S Chambers | Home Health Aide | 15473 Wisconsin, Detroit, MI 48238 | 2016-04-13 |
| 1891158788 | Karla Gill | Licensed Practical Nurse | 153060 Wildemere, Detroit, MI 48238 | 2016-03-30 |
| 1790145548 | Cecil Cosey IIi | Psychologist | 11000 W Micnichols, Detroit, MI 48238 | 2016-03-07 |
| 1508264102 | Sav-med Pharmacy Inc | Pharmacy | 2645 West Davison, Detroit, MI 48238 | 2014-12-12 |
| 1760887020 | Monument Dental PC | Dentist | 15510 Livernois Avenue, Detroit, MI 48238 | 2014-10-29 |
| Find all providers in zip 48238 | ||||
| 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 |
|---|---|---|---|---|
| 1457718165 | Shar Inc. | Substance Abuse Rehabilitation Facility | 9961 Patton St, Detroit, MI 48228-1217 | 2016-01-26 |
| 1073988333 | Sobriety House | Substance Abuse Rehabilitation Facility | 2150 E Vernor Hwy, Apt 413, Detroit, MI 48207-2744 | 2015-12-11 |
| 1003180902 | Cherry Streat Health Services | Substance Abuse Rehabilitation Facility | 11105 E Jefferson Ave, Detroit, MI 48214-3317 | 2012-02-24 |
| 1871866475 | Positive Images | Substance Abuse Rehabilitation Facility | 13336 E.warren, Detroit, MI 48229 | 2012-02-14 |
| 1861778680 | Pure Recovery Inc. | Substance Abuse Rehabilitation Facility | 19406 Norwood St, Detroit, MI 48234-1870 | 2011-10-25 |
| 1396047239 | Renaissance Recovery | Substance Abuse Rehabilitation Facility | 5250 John R St, Detroit, MI 48202-4030 | 2010-11-29 |
| 1912227075 | Juda Transitional & Recovery House | Substance Abuse Rehabilitation Facility | 5579 Vancouver St, Detroit, MI 48204-3607 | 2010-06-10 |
| 1386974913 | Stategies of Life Outreach Centers | Substance Abuse Rehabilitation Facility | 17850 Mcdougall St, Detroit, MI 48212-1040 | 2010-01-04 |
| 1922335181 | Robert IIi Baptiste Thompson | Substance Abuse Rehabilitation Facility | 2616 Puritan St, Detroit, MI 48238-1420 | 2009-11-09 |
| 1013143676 | Marian's Center for Woman's Growth | Substance Abuse Rehabilitation Facility | 5247 Sheridan St, Detroit, MI 48213-2868 | 2009-06-09 |
| Find all providers in DETROIT | ||||
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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.