Healthcare Provider Details

I. General information

NPI: 1174347249
Provider Name (Legal Business Name): RACHEL LYNN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CASPIAN DR
GRASONVILLE MD
21638-1292
US

IV. Provider business mailing address

520 CASPIAN DR
GRASONVILLE MD
21638-1292
US

V. Phone/Fax

Practice location:
  • Phone: 443-763-1473
  • Fax:
Mailing address:
  • Phone: 443-763-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES WHITLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 443-763-1473