Provider Demographics
NPI:1508980392
Name:LYNWOOD SKILLED NURSING CENTER LLC
Entity Type:Organization
Organization Name:LYNWOOD SKILLED NURSING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORLYN
Authorized Official - Middle Name:MONTES
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-207-8748
Mailing Address - Street 1:4271 CARLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-5334
Mailing Address - Country:US
Mailing Address - Phone:818-207-8748
Mailing Address - Fax:
Practice Address - Street 1:4271 CARLIN AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-5334
Practice Address - Country:US
Practice Address - Phone:818-207-8748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility