Healthcare Provider Details

I. General information

NPI: 1174577829
Provider Name (Legal Business Name): LINCOLN COMMUNITY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 TIMBERLINE DR
LINCOLN MO
65338
US

IV. Provider business mailing address

205 TIMBERLINE DR
LINCOLN MO
65338
US

V. Phone/Fax

Practice location:
  • Phone: 660-547-3322
  • Fax:
Mailing address:
  • Phone: 660-547-3322
  • Fax: 660-547-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. AUDREA KATHLEEN KREISLER
Title or Position: BUSINESS OFFICE MGR
Credential:
Phone: 660-547-3322