Provider Demographics
NPI:1598967762
Name:LAKEVIEW VIRGINIA NEUROCARE
Entity Type:Organization
Organization Name:LAKEVIEW VIRGINIA NEUROCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS,EAST
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CBIS
Authorized Official - Phone:781-356-6330
Mailing Address - Street 1:10150 HIGHLAND MANOR DR STE 140
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9712
Mailing Address - Country:US
Mailing Address - Phone:813-626-1444
Mailing Address - Fax:813-626-1444
Practice Address - Street 1:1101 E HIGH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4857
Practice Address - Country:US
Practice Address - Phone:434-984-5218
Practice Address - Fax:424-293-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA864320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities