Lynn Ann Development, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

LYNN ANN DEVELOPMENT, LLC

Doing business as

CountrySide Village

Practice address

1700 Kellenbeck Ave
Grants Pass, OR 97527-4251

Phone

(541) 956-0999

NPI assigned

Jun 23, 2020

Last updated

Jun 23, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kira Bellis

Title

Regional Business Office Manager

Phone

(541) 610-5847

Specialties & licenses 1

Addresses

Other names 1

• CountrySide Village Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1881210136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20058 BETH AVE UNIT 2",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023067",
            "telephone_number": "541-610-5847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 KELLENBECK AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975274251",
            "telephone_number": "541-956-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYNN ANN DEVELOPMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "BELLIS",
        "authorized_official_first_name": "KIRA",
        "authorized_official_title_or_position": "REGIONAL BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "541-610-5847"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CountrySide Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Collette Marie Luttmer, M.D.
• Lwafp PC Inc (Living Water Adult Family Practice)
• Brandi Ariel Lynch, LMT
• Mark Alan Lynch, FNP
• Lynda Spangler,MSW, LCSW, PC
• Justin Harrison Lyons, CADCII QMHAII CRMII
• Mathew Lytle
• Catherine Lee Mabbatt, B.S
• Elizabeth Anne Mabry, CSWI
• Jenna Marie Macaluso, QMHA

• Assisted Living Facility in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Assisted Living Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.