MEDICARE: LWM SERVICE FACILITATOR

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	251B00000X	Case Management Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1720392970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LWM SERVICE FACILITATOR

Provider Business Mailing Address
First Line	:	PO BOX 854
Second Line	:
City	:	SANDSTON
State	:	VA
Zip	:	23150-0854
Country	:	US
Telephone Number	:	804-591-5792
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CEDARWOOD RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23075-2438
Country	:	US
Telephone Number	:	804-591-5792
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CASE MANAGER
Name	:	MS. LATAWNYA C NEWSOM
Credential	:
Telephone Number	:	804-591-5792

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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