Provider Demographics
NPI:1679821870
Name:JOHN C. LINCOLN, LLC
Entity Type:Organization
Organization Name:JOHN C. LINCOLN, LLC
Other - Org Name:DBA JOHN C. LINCOLN AVISTA SENIOR LIVING NORTH MOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-434-6200
Mailing Address - Street 1:350 E EVA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 E EVA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2564
Practice Address - Country:US
Practice Address - Phone:602-544-8541
Practice Address - Fax:602-544-8543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN C. LINCOLN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty