Provider Demographics
NPI:1275734683
Name:LAWRENCEVILLE CORRECTIONAL CENTER
Entity Type:Organization
Organization Name:LAWRENCEVILLE CORRECTIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:434-848-9349
Mailing Address - Street 1:1105 STURGEON RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-2939
Mailing Address - Country:US
Mailing Address - Phone:434-848-9348
Mailing Address - Fax:
Practice Address - Street 1:1607 PLANTERS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-3350
Practice Address - Country:US
Practice Address - Phone:434-848-9348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001187570251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare