Provider Demographics
NPI:1396902235
Name:LYNN SHORE REST HOME, INC
Entity type:Organization
Organization Name:LYNN SHORE REST HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SOLIMINE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:781-595-7110
Mailing Address - Street 1:37 BREED ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3101
Mailing Address - Country:US
Mailing Address - Phone:781-595-7110
Mailing Address - Fax:781-592-2846
Practice Address - Street 1:37 BREED ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3101
Practice Address - Country:US
Practice Address - Phone:781-595-7110
Practice Address - Fax:781-592-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1287311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5505020Medicaid