MEDICARE: LAKEWOOD MANOR BAPTIST RETIREMENT COMMUNITY

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	313M00000X	Nursing Facility/Intermediate Care Facility	NH2604	VA

General Provider Information

NPI Number	:	1447491394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD MANOR BAPTIST RETIREMENT COMMUNITY

Provider Business Mailing Address
First Line	:	1900 LAUDERDALE DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-3902
Country	:	US
Telephone Number	:	804-740-2900
Fax Number	:	804-740-3774

Provider Business Practice Location Address
First Line	:	1900 LAUDERDALE DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-3902
Country	:	US
Telephone Number	:	804-740-2900
Fax Number	:	804-740-3774

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. RANDALL ROBINSON
Credential	:	D.MIN
Telephone Number	:	540-825-1569

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/20/2024

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