Provider Demographics
NPI:1528059417
Name:LINCOLN CRAWFORD
Entity type:Organization
Organization Name:LINCOLN CRAWFORD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-661-2777
Mailing Address - Street 1:2091 RADCLIFF DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45204
Mailing Address - Country:US
Mailing Address - Phone:513-661-2777
Mailing Address - Fax:
Practice Address - Street 1:1346 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1341
Practice Address - Country:US
Practice Address - Phone:513-861-2044
Practice Address - Fax:513-487-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
OH366156314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101071Medicaid
OH0101071Medicaid