Provider Demographics
NPI:1588610885
Name:LINCOLN MEDICAL HOME HEALTH & HOSPICE
Entity Type:Organization
Organization Name:LINCOLN MEDICAL HOME HEALTH & HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:GROCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-438-7471
Mailing Address - Street 1:1797 WILSON PKWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2770
Mailing Address - Country:US
Mailing Address - Phone:931-433-8088
Mailing Address - Fax:931-433-8086
Practice Address - Street 1:1797 WILSON PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2770
Practice Address - Country:US
Practice Address - Phone:931-433-8088
Practice Address - Fax:931-433-8086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000160251E00000X
TN0000000375251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44-7247Medicare PIN
TN441530Medicare ID - Type UnspecifiedHOSPICE
TN447247Medicare ID - Type UnspecifiedHOME HEALTH CARE