1891782405 NPI number — LINCOLN CARE

Table of content: (NPI 1891782405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891782405 NPI number — LINCOLN CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LINCOLN AND DONALSON CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891782405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 AMANA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37334-3365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-433-6146
Provider Business Mailing Address Fax Number:
931-433-0816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 AMANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37334-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-433-6146
Provider Business Practice Location Address Fax Number:
931-433-0816
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ATCHLEY
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
931-433-6146

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  0000000159 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 0000000159 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7440054 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0045173 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1452393 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3112914 . This is a "BLUE CROSS BLUE SHIELD OF TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com