Provider Demographics
NPI:1346951969
Name:LACYCASEMANAGEMENT INC
Entity Type:Organization
Organization Name:LACYCASEMANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:404-213-8517
Mailing Address - Street 1:1420 FOXHALL LN SE APT 8
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3474
Mailing Address - Country:US
Mailing Address - Phone:404-213-8517
Mailing Address - Fax:404-328-0999
Practice Address - Street 1:1420 FOXHALL LN SE APT 8
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3474
Practice Address - Country:US
Practice Address - Phone:404-213-8517
Practice Address - Fax:404-328-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00628559AMedicaid