Provider Demographics
NPI:1174577829
Name:LINCOLN COMMUNITY NURSING HOME
Entity type:Organization
Organization Name:LINCOLN COMMUNITY NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:KREISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-547-3322
Mailing Address - Street 1:205 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MO
Mailing Address - Zip Code:65338
Mailing Address - Country:US
Mailing Address - Phone:660-547-3322
Mailing Address - Fax:660-547-3484
Practice Address - Street 1:205 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MO
Practice Address - Zip Code:65338
Practice Address - Country:US
Practice Address - Phone:660-547-3322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101489607Medicaid
MO031637OtherLICENSE #
MO265761Medicare Oscar/Certification
MO4875490001Medicare NSC