MEDICARE: LYNN'S PERSONAL CARE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	PCH008162	GA

General Provider Information

NPI Number	:	1225476047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNN'S PERSONAL CARE HOME

Provider Business Mailing Address
First Line	:	3649 GA HIGHWAY 88
Second Line	:
City	:	BLYTHE
State	:	GA
Zip	:	30805-3620
Country	:	US
Telephone Number	:	706-592-6651
Fax Number	:	706-793-0950

Provider Business Practice Location Address
First Line	:	3350 PEACH ORCHARD RD STE 807
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-5932
Country	:	US
Telephone Number	:	706-793-0971
Fax Number	:	706-793-0950

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MRS. LINDA JEAN CURRY
Credential	:	REGISTERED NURSE
Telephone Number	:	706-631-3169

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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