Provider Demographics
NPI:1770824286
Name:LINCOLN LTC, LLC
Entity Type:Organization
Organization Name:LINCOLN LTC, LLC
Other - Org Name:SILVER CROSS NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:G.
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-849-2294
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-1490
Mailing Address - Country:US
Mailing Address - Phone:601-849-2294
Mailing Address - Fax:
Practice Address - Street 1:503 SILVER CROSS DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2388
Practice Address - Country:US
Practice Address - Phone:601-833-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility