Healthcare Provider Details

I. General information

NPI: 1639918535
Provider Name (Legal Business Name): GREATER LYNN SENIOR SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 10/07/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SILSBEE ST
LYNN MA
01901-1404
US

IV. Provider business mailing address

8 SILSBEE ST
LYNN MA
01901-1404
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-0110
  • Fax:
Mailing address:
  • Phone: 781-599-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: CAROL M MILLS
Title or Position: DATA APPLICATION SPECIALIST
Credential: AO
Phone: 781-586-8505