Healthcare Provider Details

I. General information

NPI: 1710033139
Provider Name (Legal Business Name): LINCOLN IL/AL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 A ST
LINCOLN NE
68510-5134
US

IV. Provider business mailing address

6800 A ST
LINCOLN NE
68510-5134
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-1010
  • Fax: 402-483-2197
Mailing address:
  • Phone: 402-483-1010
  • Fax: 402-483-2197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN LITT
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 646-844-3603