Healthcare Provider Details

I. General information

NPI: 1770824286
Provider Name (Legal Business Name): LINCOLN LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 SILVER CROSS DR
BROOKHAVEN MS
39601-2388
US

IV. Provider business mailing address

PO BOX 1490
MAGEE MS
39111-1490
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-2361
  • Fax:
Mailing address:
  • Phone: 601-849-2294
  • Fax:

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: MR. G. BENNETT HUBBARD JR.
Title or Position: MEMBER/MANAGER
Credential:
Phone: 601-849-2294