Healthcare Provider Details

I. General information

NPI: 1457288805
Provider Name (Legal Business Name): LINCOLN HEALTHCARE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5431 S 16TH ST
LINCOLN NE
68512-1206
US

IV. Provider business mailing address

951 W. OVERLAND ROAD SUITE 143
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 531-739-3200
  • Fax: 531-739-3299
Mailing address:
  • Phone:
  • 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: BRANTLEY SHATTUCK
Title or Position: MANAGING PARTNER
Credential:
Phone: 208-206-0261