Provider Demographics
NPI:1902295512
Name:LYSAL PROF. MKTG. & HOME HEALTHCARE MNGMT. GROUP INC
Entity Type:Organization
Organization Name:LYSAL PROF. MKTG. & HOME HEALTHCARE MNGMT. GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:904-759-5089
Mailing Address - Street 1:7225 SHARBETH DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4753
Mailing Address - Country:US
Mailing Address - Phone:855-334-3339
Mailing Address - Fax:904-573-2610
Practice Address - Street 1:7225 SHARBETH DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4753
Practice Address - Country:US
Practice Address - Phone:855-334-3339
Practice Address - Fax:904-573-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8370101YM0800X
FLARNP9300116363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty