Provider Demographics
NPI:1326568205
Name:LUMZY'S RESIDENTIAL INC
Entity Type:Organization
Organization Name:LUMZY'S RESIDENTIAL INC
Other - Org Name:LUMZY'S RESIDENTIAL SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAVERNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMZY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-279-0105
Mailing Address - Street 1:6601 IRONGATE SQ STE D
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-6077
Mailing Address - Country:US
Mailing Address - Phone:804-279-0105
Mailing Address - Fax:804-279-0109
Practice Address - Street 1:7433 COTFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-1841
Practice Address - Country:US
Practice Address - Phone:804-279-0105
Practice Address - Fax:804-279-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0049474106320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0049474106Medicaid