Provider Demographics
NPI:1477213031
Name:LYNN COMMUNITY HEALTH, INC.
Entity Type:Organization
Organization Name:LYNN COMMUNITY HEALTH, INC.
Other - Org Name:LYNN COMMUNITY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIAME
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MAHANIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-596-2502
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01903-0626
Mailing Address - Country:US
Mailing Address - Phone:781-596-2502
Mailing Address - Fax:781-596-3966
Practice Address - Street 1:269 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1314
Practice Address - Country:US
Practice Address - Phone:781-581-3900
Practice Address - Fax:781-598-1050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYNN COMMUNITY HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-23
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA221810Medicaid