Provider Demographics
NPI:1427742816
Name:LGMOLLICA GROUP, LLC
Entity type:Organization
Organization Name:LGMOLLICA GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GODAR-MOLLICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-246-1862
Mailing Address - Street 1:14408 NE 30TH PL APT C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3220
Mailing Address - Country:US
Mailing Address - Phone:561-246-1862
Mailing Address - Fax:
Practice Address - Street 1:11900 NE 1ST ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3049
Practice Address - Country:US
Practice Address - Phone:561-246-1862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care