MEDICARE: LAWRENCE MANOR LLC

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	314000000X	Skilled Nursing Facility	1887	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679560098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE MANOR LLC

Provider Business Mailing Address
First Line	:	26 HENRY AVE
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01902-4008
Country	:	US
Telephone Number	:	781-595-5553
Fax Number	:	781-596-3636

Provider Business Practice Location Address
First Line	:	26 HENRY AVE
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01902-4008
Country	:	US
Telephone Number	:	781-595-5553
Fax Number	:	781-596-3636

Authorized Official
Title or Position	:	OWNER ADMINISTRATOR
Name	:	MR. TERRENCE M O'CONNELL
Credential	:
Telephone Number	:	781-595-5553

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	05/09/2008

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Directions to “LAWRENCE MANOR LLC ” Practice Location

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