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General NPI Number Information
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NPI Number | 1447491394
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Entity Type | Organization
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Legal Business Name | LAKEWOOD MANOR BAPTIST RETIREMENT COMMUNITY
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 1900 LAUDERDALE DR
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City | RICHMOND
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State | VA
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Zip | 23238-3902
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Country | US
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Telephone | 804-740-2900
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Fax | 804-740-3774
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Provider Business Mailing Address
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Address Line | 1900 LAUDERDALE DR
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City | RICHMOND
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State | VA
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Zip | 23238-3902
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Country | US
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Telephone | 804-740-2900
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Fax | 804-740-3774
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. RANDALL ROBINSON
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Credential | D.MIN
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Telephone | 540-825-1569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH2604
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License Number State | VA
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