Provider Demographics
NPI:1700028909
Name:LINCOLN PARK MANOR INC.
Entity Type:Organization
Organization Name:LINCOLN PARK MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-524-4428
Mailing Address - Street 1:1842 K 18
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67422-9000
Mailing Address - Country:US
Mailing Address - Phone:785-820-0309
Mailing Address - Fax:785-524-3522
Practice Address - Street 1:922 N 5TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:KS
Practice Address - Zip Code:67455-1602
Practice Address - Country:US
Practice Address - Phone:785-524-4428
Practice Address - Fax:785-524-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA053002251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS171535Medicare PIN