Provider Demographics
NPI:1962912626
Name:LINCOLIN CO ASSISTED LIVING
Entity type:Organization
Organization Name:LINCOLIN CO ASSISTED LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:870-941-6734
Mailing Address - Street 1:142 TEVA DR
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71667-4253
Mailing Address - Country:US
Mailing Address - Phone:870-941-6734
Mailing Address - Fax:
Practice Address - Street 1:142 TEVA DR
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:AR
Practice Address - Zip Code:71667-4253
Practice Address - Country:US
Practice Address - Phone:870-941-6734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility