Healthcare Provider Details

I. General information

NPI: 1588610885
Provider Name (Legal Business Name): LINCOLN MEDICAL HOME HEALTH & HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1797 WILSON PKWY
FAYETTEVILLE TN
37334-2770
US

IV. Provider business mailing address

1797 WILSON PKWY
FAYETTEVILLE TN
37334-2770
US

V. Phone/Fax

Practice location:
  • Phone: 931-433-8088
  • Fax: 931-433-8086
Mailing address:
  • Phone: 931-433-8088
  • Fax: 931-433-8086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0000000160
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0000000375
License Number StateTN

VIII. Authorized Official

Name: MR. DAVID R. GROCE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 931-438-7471