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General NPI Number Information
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NPI Number | 1396902235
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Entity Type | Organization
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Legal Business Name | LYNN SHORE REST HOME, INC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 37 BREED ST
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City | LYNN
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State | MA
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Zip | 01902-3101
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Country | US
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Telephone | 781-595-7110
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Fax | 781-592-2846
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Provider Business Mailing Address
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Address Line | 37 BREED ST
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City | LYNN
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State | MA
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Zip | 01902-3101
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Country | US
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Telephone | 781-595-7110
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Fax | 781-592-2846
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SUSAN MARY SOLIMINE
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Credential | RN
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Telephone | 781-595-7110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 1287
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License Number State | MA
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