Provider Demographics
NPI:1720392970
Name:LWM SERVICE FACILITATOR
Entity Type:Organization
Organization Name:LWM SERVICE FACILITATOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATAWNYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-591-5792
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-0854
Mailing Address - Country:US
Mailing Address - Phone:804-591-5792
Mailing Address - Fax:
Practice Address - Street 1:300 CEDARWOOD RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23075-2438
Practice Address - Country:US
Practice Address - Phone:804-591-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LWM BUSINESS SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management