Organization
LUCAS LODGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA LUCAS BURKE (ASSISTANT EXECUTIVE DIRECTOR)
(757) 397-8200
Entity
Organization
Contact information
Practice address
1214 COUNTY ST, PORTSMOUTH, VA 23704-3240
(757) 397-8200
(757) 397-8224
Mailing address
1214 COUNTY ST, PORTSMOUTH, VA 23704-3240
(757) 397-8200
(757) 397-8224
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
341-01-001
VA
Other
Enumeration date
07/12/2006
Last updated
08/22/2020
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