Provider Demographics
NPI:1992713812
Name:LUCY CORR NURSING HOME
Entity type:Organization
Organization Name:LUCY CORR NURSING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-706-5711
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:6800 LUCY CORR BLVD
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-0170
Mailing Address - Country:US
Mailing Address - Phone:804-748-1511
Mailing Address - Fax:804-796-6285
Practice Address - Street 1:6800 LUCY CORR BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-0170
Practice Address - Country:US
Practice Address - Phone:804-748-1511
Practice Address - Fax:804-796-6285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTERFIELD COUNTY HEALTH CENTER COMMONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-04
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2615314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA495079-8Medicaid
VA495079-8Medicaid
VA495079Medicare ID - Type UnspecifiedOTHER