=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174198469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THEKEY OF LYNCHBURG LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2021
-----------------------------------------------------
Last Update Date | 04/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1133 2ND ST SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24016-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-776-3622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1133 2ND ST SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24016-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-776-3622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL DIRECTOR
-----------------------------------------------------
Name | MR. ANDY E TYSINGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-419-2369
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------