Basic Information
| Provider Information | |||||||||
| NPI: | 1083074074 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LINCO HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 N DREW ST | ||||||||
| Address2: | |||||||||
| City: | STAR CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716675728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706284144 | ||||||||
| FaxNumber: | 8706284891 | ||||||||
| Practice Location | |||||||||
| Address1: | 702 N DREW ST | ||||||||
| Address2: | |||||||||
| City: | STAR CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716675728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706284144 | ||||||||
| FaxNumber: | 8706284891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2016 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | BRANDON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5019320050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RHC OPERATIONS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1113 | 01 | AR | FACILITY LICENSE | OTHER | 212876311 | 05 | AR | MEDICAID |