Provider Demographics
NPI:1790125466
Name:LP KNOXVILLE, LLC
Entity Type:Organization
Organization Name:LP KNOXVILLE, LLC
Other - Org Name:LINCOLN PARK HEALTH & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:3300 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-2733
Mailing Address - Country:US
Mailing Address - Phone:865-689-2052
Mailing Address - Fax:865-689-8670
Practice Address - Street 1:3300 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-2733
Practice Address - Country:US
Practice Address - Phone:865-689-2052
Practice Address - Fax:865-689-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
445297Medicare Oscar/Certification