Provider Demographics
NPI:1205596079
Name:LINCOLN TRAIL HOMECARE
Entity type:Organization
Organization Name:LINCOLN TRAIL HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-348-0377
Mailing Address - Street 1:102 MANOR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2553
Mailing Address - Country:US
Mailing Address - Phone:502-348-0377
Mailing Address - Fax:
Practice Address - Street 1:102 MANOR AVE STE 201
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2553
Practice Address - Country:US
Practice Address - Phone:502-348-0377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care