Provider Demographics
NPI:1821562729
Name:ACHILA, LAKEZIA ANN (CEO)
Entity Type:Individual
Prefix:MRS
First Name:LAKEZIA
Middle Name:ANN
Last Name:ACHILA
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 DARSENA
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6501
Mailing Address - Country:US
Mailing Address - Phone:972-522-8909
Mailing Address - Fax:
Practice Address - Street 1:7312 DARSENA
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6501
Practice Address - Country:US
Practice Address - Phone:972-522-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320800000X
TXNA0000809151376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821562729Medicaid