Healthcare Provider Details

I. General information

NPI: 1548020647
Provider Name (Legal Business Name): LYNN HEALTH CONSULTANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 28TH PL SE
WASHINGTON DC
20020-3809
US

IV. Provider business mailing address

1619 28TH PL SE
WASHINGTON DC
20020-3809
US

V. Phone/Fax

Practice location:
  • Phone: 202-498-8094
  • Fax:
Mailing address:
  • Phone: 202-498-8094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LYNNJULIE AUGUSTINE NKWABA
Title or Position: PRESIDENT
Credential:
Phone: 202-498-8094