Provider Demographics
NPI:1023092251
Name:LANCASTER MEDICAL INVESTORS LLC
Entity type:Organization
Organization Name:LANCASTER MEDICAL INVESTORS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-975-5455
Mailing Address - Street 1:308 WEST MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444
Mailing Address - Country:US
Mailing Address - Phone:859-792-6844
Mailing Address - Fax:859-792-1806
Practice Address - Street 1:308 WEST MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444
Practice Address - Country:US
Practice Address - Phone:859-792-6844
Practice Address - Fax:859-792-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100719313M00000X
KY1000719314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504551Medicaid
185065Medicare Oscar/Certification
6097470001Medicare NSC