Provider Demographics
NPI:1124234299
Name:LYNN'S HERITAGE HOUSE, INC
Entity type:Organization
Organization Name:LYNN'S HERITAGE HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-754-4020
Mailing Address - Street 1:800 KELLY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISIANA
Mailing Address - State:MO
Mailing Address - Zip Code:63353-2415
Mailing Address - Country:US
Mailing Address - Phone:573-754-4020
Mailing Address - Fax:573-754-4306
Practice Address - Street 1:800 KELLY LN
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353-2415
Practice Address - Country:US
Practice Address - Phone:573-754-4020
Practice Address - Fax:573-754-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO025974310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility