Organization
LAKEWOOD ADULT FAMILY HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD JAMES CHURCH (ADMINISTRATOR)
(802) 468-3010
Entity
Organization
Contact information
Practice address
69 RAINBOWS END, BOMOSEEN, VT 05732-4417
(802) 468-3010
(802) 468-5374
Mailing address
POB 1543, CASTLETON, VT 05735-1543
(802) 468-3010
(802) 468-5374
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
544
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047W278
—
VT
Enumeration date
06/18/2007
Last updated
06/24/2008
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