Provider Demographics
NPI:1306823919
Name:IHS ACQUISITION NO 114 INC
Entity Type:Organization
Organization Name:IHS ACQUISITION NO 114 INC
Other - Org Name:LYNWOOD MANOR HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-513-8738
Mailing Address - Street 1:730 KIMOLE LANE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1463
Mailing Address - Country:US
Mailing Address - Phone:517-263-6771
Mailing Address - Fax:517-265-8599
Practice Address - Street 1:730 KIMOLE LANE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1463
Practice Address - Country:US
Practice Address - Phone:517-263-6771
Practice Address - Fax:517-265-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISNFLTC464050314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI604163621Medicaid
MI604163621Medicaid