Provider Demographics
NPI:1447491394
Name:LAKEWOOD MANOR BAPTIST RETIREMENT COMMUNITY
Entity type:Organization
Organization Name:LAKEWOOD MANOR BAPTIST RETIREMENT COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:540-825-1569
Mailing Address - Street 1:1900 LAUDERDALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3902
Mailing Address - Country:US
Mailing Address - Phone:804-740-2900
Mailing Address - Fax:804-740-3774
Practice Address - Street 1:1900 LAUDERDALE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-3902
Practice Address - Country:US
Practice Address - Phone:804-740-2900
Practice Address - Fax:804-740-3774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA BAPTIST HOMES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-23
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2604313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility