=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467352096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYNNS CARE VILLAGE ASSOCIATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2026
-----------------------------------------------------
Last Update Date | 11/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6809 SANDY FORKS RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-7318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-621-9670
-----------------------------------------------------
Fax | 919-516-0796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10215
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27605-0215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-621-9670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANN MARIE CASSELLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-621-9670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------