Provider Demographics
NPI:1346279544
Name:LYNN HAVEN NURSING HOME LLC
Entity Type:Organization
Organization Name:LYNN HAVEN NURSING HOME LLC
Other - Org Name:LYNN HAVEN HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-986-3196
Mailing Address - Street 1:747 MONTICELLO HWY
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-3103
Mailing Address - Country:US
Mailing Address - Phone:478-986-3196
Mailing Address - Fax:478-986-1377
Practice Address - Street 1:747 MONTICELLO HWY
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-3103
Practice Address - Country:US
Practice Address - Phone:478-986-3196
Practice Address - Fax:478-986-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-084-1786314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00083036AMedicaid
51003337 001OtherBCBS
115474Medicare Oscar/Certification