Provider Demographics
NPI:1073706198
Name:LYNNDALE, INC.
Entity Type:Organization
Organization Name:LYNNDALE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-738-3395
Mailing Address - Street 1:1490 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5935
Mailing Address - Country:US
Mailing Address - Phone:706-738-3395
Mailing Address - Fax:706-738-3335
Practice Address - Street 1:1490 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5935
Practice Address - Country:US
Practice Address - Phone:706-738-3395
Practice Address - Fax:706-738-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services