=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992819346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYNCO MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52 BEECHWOOD DR
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-983-1122
-----------------------------------------------------
Fax | 978-683-0101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52 BEECHWOOD DR
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-983-1122
-----------------------------------------------------
Fax | 978-683-0101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. JERRY LYNCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-683-1122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 7227
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------