Provider Demographics
NPI:1528267747
Name:MAINES, S LYNELLE
Entity type:Individual
Prefix:
First Name:S
Middle Name:LYNELLE
Last Name:MAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12790 BASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-8317
Mailing Address - Country:US
Mailing Address - Phone:440-286-5704
Mailing Address - Fax:440-286-5704
Practice Address - Street 1:12790 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-8317
Practice Address - Country:US
Practice Address - Phone:440-286-5704
Practice Address - Fax:440-286-5704
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2703257Medicaid