Provider Demographics
NPI:1710033139
Name:LINCOLN IL/AL, LLC
Entity Type:Organization
Organization Name:LINCOLN IL/AL, LLC
Other - Org Name:THE RESIDENCE AT GRAMERCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-844-3603
Mailing Address - Street 1:6800 A ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-5134
Mailing Address - Country:US
Mailing Address - Phone:402-483-1010
Mailing Address - Fax:402-483-2197
Practice Address - Street 1:6800 A ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-5134
Practice Address - Country:US
Practice Address - Phone:402-483-1010
Practice Address - Fax:402-483-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100253009Medicaid
NE100268602Medicaid