Healthcare Provider Details

I. General information

NPI: 1306678206
Provider Name (Legal Business Name): LINX COMMUNITY SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 WILLIAMSTOWN PIKE
WILLIAMSTOWN WV
26187-8168
US

IV. Provider business mailing address

1307 WILLIAMSTOWN PIKE
WILLIAMSTOWN WV
26187-8168
US

V. Phone/Fax

Practice location:
  • Phone: 304-834-4619
  • Fax:
Mailing address:
  • Phone: 304-834-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON SCOTT LYNCH
Title or Position: MEMBER
Credential:
Phone: 304-834-4619