Provider Demographics
NPI:1518437474
Name:LAKEWOOD RESOURCE AND REFERRAL CENTER, INC.
Entity Type:Organization
Organization Name:LAKEWOOD RESOURCE AND REFERRAL CENTER, INC.
Other - Org Name:CENTER FOR HEALTH EDUCATION, MEDICINE AND DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-364-2144
Mailing Address - Street 1:1771 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1242
Mailing Address - Country:US
Mailing Address - Phone:732-364-2144
Mailing Address - Fax:
Practice Address - Street 1:485 LOCUST ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5896
Practice Address - Country:US
Practice Address - Phone:732-364-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEWOOD RESOURCE AND REFERRAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-04
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)