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General NPI Number Information
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NPI Number | 1801940929
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Entity Type | Organization
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Legal Business Name | LAKES REGIONAL MHMR CENTER
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 400 AIRPORT RD
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City | TERRELL
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State | TX
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Zip | 75160-4302
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Country | US
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Telephone | 972-388-2000
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Fax | 972-388-2010
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Provider Business Mailing Address
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Address Line | 400 AIRPORT RD
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City | TERRELL
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State | TX
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Zip | 75160-4302
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Country | US
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Telephone | 972-388-2000
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Fax | 972-388-2010
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Authorized Official
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Title or Position | CFO
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Name | MR. ERWIN HANCOCK
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Credential |
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Telephone | 972-388-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001012281
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001012282
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001007185
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 001010201
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 001010609
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001012279
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001012280
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License Number State | TX
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Taxonomy #8
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001008029
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License Number State | TX
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