1285346114 NPI number — LINCOLN LAND COMMUNITY PARTNERS

Table of content: (NPI 1285346114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285346114 NPI number — LINCOLN LAND COMMUNITY PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN LAND COMMUNITY PARTNERS
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:
Provider Other Organization Name Type Code:
6
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:
1285346114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E MADISON ST APT 126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62701-1068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-720-2943
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 E MADISON ST APT 126
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62701-1068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-720-2943
Provider Business Practice Location Address Fax Number:
217-775-0902
Provider Enumeration Date:
12/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BARLOW-JOHNSON
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
217-953-5076

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com