Provider Demographics
NPI:1518094077
Name:LYNN COMMUNITY ELDER SERVICES
Entity Type:Organization
Organization Name:LYNN COMMUNITY ELDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-599-0110
Mailing Address - Street 1:8 SILSBEE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1404
Mailing Address - Country:US
Mailing Address - Phone:781-599-0110
Mailing Address - Fax:
Practice Address - Street 1:8 SILSBEE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1404
Practice Address - Country:US
Practice Address - Phone:781-599-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA042581129261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1903624Medicare ID - Type UnspecifiedADH
MA1903632Medicare ID - Type UnspecifiedALZ