MEDICARE: LAKEWOOD SENIOR LIVING-DRUMS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	177F00000X	Lodging Provider

General Provider Information

NPI Number	:	1033813530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD SENIOR LIVING-DRUMS, LLC

Provider Business Mailing Address
First Line	:	3008 7TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-3503
Country	:	US
Telephone Number	:	205-837-5336
Fax Number	:	205-320-7595

Provider Business Practice Location Address
First Line	:	159 S OLD TURNPIKE RD
Second Line	:
City	:	DRUMS
State	:	PA
Zip	:	18222-1726
Country	:	US
Telephone Number	:	570-788-4178
Fax Number	:	570-788-5906

Authorized Official
Title or Position	:	MANAGER
Name	:	RICHARD JAMES BROCKMAN
Credential	:
Telephone Number	:	205-837-5336

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	03/28/2023

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