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NPI Code Detail

MEDICARE: LINCOLN CITY, LLC

MEDICARE: LINCOLN CITY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility800038OR

General Provider Information

NPI Number : 1639176779
Entity Type Code : Organization
Provider Name (Legal Business Name) : LINCOLN CITY, LLC
Provider Business Mailing Address
First Line : 1077 GATEWAY LOOP
Second Line :
City : SPRINGFIELD
State : OR
Zip : 97477-1114
Country : US
Telephone Number : 541-746-1020
Fax Number : 541-284-7072
Provider Business Practice Location Address
First Line : 3011 NE 28TH ST
Second Line :
City : LINCOLN CITY
State : OR
Zip : 97367-4518
Country : US
Telephone Number : 541-994-8111
Fax Number : 541-994-3399
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. MARK GARBER
Credential :
Telephone Number : 541-746-1020
Provider Enumeration Date : 07/05/2005
Last Update Date : 02/23/2015

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Directions to “LINCOLN CITY, LLC ” Practice Location

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