Provider Demographics
NPI:1164002234
Name:LAKE CASE MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:LAKE CASE MANAGEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-230-5794
Mailing Address - Street 1:8140 NW 155TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5847
Mailing Address - Country:US
Mailing Address - Phone:305-602-8193
Mailing Address - Fax:305-602-8194
Practice Address - Street 1:8140 NW 155TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5847
Practice Address - Country:US
Practice Address - Phone:305-602-8193
Practice Address - Fax:305-602-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management