Provider Demographics
NPI:1114780608
Name:CARE LYNN HEALTH & WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:CARE LYNN HEALTH & WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASANTEWAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:708-518-1692
Mailing Address - Street 1:3736 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3714
Mailing Address - Country:US
Mailing Address - Phone:708-518-1692
Mailing Address - Fax:
Practice Address - Street 1:3736 W 86TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3714
Practice Address - Country:US
Practice Address - Phone:708-518-1692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No342000000XTransportation ServicesTransportation Network Company