MEDICARE: LYNN HOUSE OF POTOMAC VALLEY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374T00000X	Religious Nonmedical Nursing Personnel

General Provider Information

NPI Number	:	1235235805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNN HOUSE OF POTOMAC VALLEY INC

Provider Business Mailing Address
First Line	:	4400 W BRADDOCK ROAD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-1010
Country	:	US
Telephone Number	:	703-379-6000
Fax Number	:	703-671-8897

Provider Business Practice Location Address
First Line	:	4400 W BRADDOCK RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-1010
Country	:	US
Telephone Number	:	703-379-6000
Fax Number	:	703-671-8897

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SUSAN ORTTUNG
Credential	:
Telephone Number	:	703-379-6000

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	09/12/2022

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