Provider Demographics
NPI:1891782405
Name:LINCOLN CARE
Entity type:Organization
Organization Name:LINCOLN CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:ATCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-433-6146
Mailing Address - Street 1:501 AMANA AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3365
Mailing Address - Country:US
Mailing Address - Phone:931-433-6146
Mailing Address - Fax:931-433-0816
Practice Address - Street 1:501 AMANA AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3365
Practice Address - Country:US
Practice Address - Phone:931-433-6146
Practice Address - Fax:931-433-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000159313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440054Medicaid
TN0045173Medicaid
TN1452393Medicaid
TN3112914OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
TN1452393Medicaid
TN7440054Medicaid