MEDICARE: NATIONAL CHURCH RESIDENCES LINCOLN LODGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2487R	OTHER	OH	RESIDENTIAL CARE LICENSE

General Provider Information

NPI Number	:	1710228416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL CHURCH RESIDENCES LINCOLN LODGE

Provider Business Mailing Address
First Line	:	5475 RINGS RD STE 300
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-7537
Country	:	US
Telephone Number	:	614-451-2151
Fax Number	:	614-442-7040

Provider Business Practice Location Address
First Line	:	4959 MEDFIELD WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1653
Country	:	US
Telephone Number	:	614-870-1123
Fax Number	:	614-853-2509

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIANNA METTLER
Credential	:
Telephone Number	:	614-451-2151

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	11/04/2025

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