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General NPI Number Information
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NPI Number | 1093704249
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Entity Type | Organization
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Legal Business Name | LINCOLN GLEN SKILLED NURSING FACILITY
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 2671 PLUMMER AVE
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City | SAN JOSE
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State | CA
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Zip | 95125-4867
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Country | US
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Telephone | 408-265-3222
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Fax | 408-448-1533
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Provider Business Mailing Address
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Address Line | 2671 PLUMMER AVE
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City | SAN JOSE
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State | CA
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Zip | 95125-4867
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Country | US
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Telephone | 408-265-3222
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Fax | 408-448-1533
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAMES BRADLEY MORTENSEN
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Credential | LNHA
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Telephone | 408-757-8580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 31400000X
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License Number State | CA
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