1952389272 NPI number — LITTLE SERVANT SISTERS - ST. JOSEPH'S HOME ASSISTED LIVING AND NURSING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952389272 NPI number — LITTLE SERVANT SISTERS - ST. JOSEPH'S HOME ASSISTED LIVING AND NURSING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE SERVANT SISTERS - ST. JOSEPH'S HOME ASSISTED LIVING AND NURSING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952389272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1-3 SAINT JOSEPH TERR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07095-2611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-750-0077
Provider Business Mailing Address Fax Number:
732-634-1811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1-3 SAINT JOSEPH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07095-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-750-0077
Provider Business Practice Location Address Fax Number:
732-634-1811
Provider Enumeration Date:
01/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRADOWSKA
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
MDS COORDINATOR
Authorized Official Telephone Number:
732-750-0077

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  061223 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5353301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5353319 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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