MEDICARE: MIKERLINE LYNS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251X00000X	Supports Brokerage Agency
2	253J00000X	Foster Care Agency
3	253Z00000X	In Home Supportive Care Agency
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
5	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1831700020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKERLINE LYNS

Provider Business Mailing Address
First Line	:	433 PLAZA REAL STE 275
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-3999
Country	:	US
Telephone Number	:	561-781-7036
Fax Number	:	561-781-7037

Provider Business Practice Location Address
First Line	:	10941 WINDING CREEK LN
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-5664
Country	:	US
Telephone Number	:	954-336-8483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2020
Last Update Date	:	05/31/2023

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