Healthcare Provider Details

I. General information

NPI: 1316162860
Provider Name (Legal Business Name): LYNNS INDEPENDENT HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4887 ANDERSON ANTHONY RD
LEAVITTSBURG OH
44430-9765
US

IV. Provider business mailing address

4887 ANDERSON ANTHONY RD
LEAVITTSBURG OH
44430-9765
US

V. Phone/Fax

Practice location:
  • Phone: 330-898-6507
  • Fax: 330-898-1333
Mailing address:
  • Phone: 330-898-6507
  • Fax: 330-898-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number400603450407
License Number StateOH

VIII. Authorized Official

Name: LYNN VERONICA BROWN
Title or Position: HOME HEALTH AIDE
Credential:
Phone: 330-898-6507