Healthcare Provider Details

I. General information

NPI: 1558589903
Provider Name (Legal Business Name): LAKE ARLINGTON HOLDING COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6702 W POLY WEBB RD
ARLINGTON TX
76016-3615
US

IV. Provider business mailing address

6702 W POLY WEBB RD
ARLINGTON TX
76016-3615
US

V. Phone/Fax

Practice location:
  • Phone: 817-478-0095
  • Fax: 817-478-7628
Mailing address:
  • Phone: 817-478-0095
  • Fax: 817-478-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL WALKER
Title or Position: ADMIN DIRECTOR
Credential: ED.D.
Phone: 817-478-0095