Basic Information
| Provider Information | |||||||||
| NPI: | 1619921061 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | T-LYNN INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | WOODBRIAR NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 CATHERINE ST | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724321100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705782483 | ||||||||
| FaxNumber: | 8705782485 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 MCLAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721123529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705234333 | ||||||||
| FaxNumber: | 8705234341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 07/23/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SAMPSON | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | AGENT | ||||||||
| AuthorizedOfficialTelephone: | 8705234333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 620 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.