Lakewood Adult Family Home Inc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

544 Issued in VT

Legal business name

LAKEWOOD ADULT FAMILY HOME INC

Practice address

69 Rainbows End
Bomoseen, VT 05732-4417

Phone

(802) 468-3010

Fax

(802) 468-5374

NPI assigned

Jun 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Richard James Church

Title

Administrator

Phone

(802) 468-3010

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1194920488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POB 1543",
            "city": "CASTLETON",
            "state": "VT",
            "postal_code": "057351543",
            "telephone_number": "802-468-3010",
            "fax_number": "802-468-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 RAINBOWS END",
            "city": "BOMOSEEN",
            "state": "VT",
            "postal_code": "057324417",
            "telephone_number": "802-468-3010",
            "fax_number": "802-468-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD ADULT FAMILY HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "802-468-3010",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "VT",
            "license": "544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047W278",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Joiner, NP
• Pauline Kahng, PA
• Stephen S Kornbluth, M.D.
• KPH Healthcare Services, Inc.
• Hannah Mary Kussel, PHARM D
• Jessica C Lindert, RN
• Colleen Mitchell, FNP
• Laura Morin, APRN
• Gabrielle Myrick, FNP
• Lara K Peck, RD CDE

• All providers in Bomoseen, VT
• Adult Care Home Facility in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.