Provider Demographics
NPI:1225203797
Name:LYNGRETT ENTERPRISES INC
Entity Type:Organization
Organization Name:LYNGRETT ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVETA
Authorized Official - Middle Name:LYNGRETT
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-7774
Mailing Address - Street 1:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-0496
Mailing Address - Country:US
Mailing Address - Phone:252-523-7774
Mailing Address - Fax:252-523-7772
Practice Address - Street 1:225 S HANCOCK ST STE A
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3679
Practice Address - Country:US
Practice Address - Phone:910-978-1929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health