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General NPI Number Information
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NPI Number | 1275734683
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Entity Type | Organization
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Legal Business Name | LAWRENCEVILLE CORRECTIONAL CENTER
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1607 PLANTERS RD
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-3350
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Country | US
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Telephone | 434-848-9348
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 STURGEON RD
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-2939
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Country | US
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Telephone | 434-848-9348
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Fax |
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Authorized Official
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Title or Position | NURSE SUPERVISOR
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Name | TRACIE D. SEWARD
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Credential | RN
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Telephone | 434-848-9349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 0001187570
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License Number State | VA
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