Provider Demographics
NPI:1093111254
Name:LYNNWOOD ASSISTED LIVING
Entity Type:Organization
Organization Name:LYNNWOOD ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-998-4533
Mailing Address - Street 1:1801 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TAHOKA
Mailing Address - State:TX
Mailing Address - Zip Code:79373-5105
Mailing Address - Country:US
Mailing Address - Phone:806-998-1226
Mailing Address - Fax:806-561-4049
Practice Address - Street 1:1801 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TAHOKA
Practice Address - State:TX
Practice Address - Zip Code:79373-5105
Practice Address - Country:US
Practice Address - Phone:806-998-1226
Practice Address - Fax:806-561-4049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYNN COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-14
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility