Healthcare Provider Details

I. General information

NPI: 1598481616
Provider Name (Legal Business Name): LINCOLN TECHNOLOGY & ASSESSMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7672 HIGHWAY 822 DUBACH
DUBACH LA
71235-7123
US

IV. Provider business mailing address

7672 HIGHWAY 822
DUBACH LA
71235-3109
US

V. Phone/Fax

Practice location:
  • Phone: 318-243-3050
  • Fax:
Mailing address:
  • Phone: 318-243-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA WINGARD
Title or Position: OWNER
Credential:
Phone: 318-243-3050