1881684066 NPI number — LUTHERAN HOME AT MOORESTOWN

Table of content: (NPI 1881684066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881684066 NPI number — LUTHERAN HOME AT MOORESTOWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN HOME AT MOORESTOWN
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:
LUTHERAN CROSSINGS ENHANCED LIVING
Provider Other Organization Name Type Code:
3
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:
1881684066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 MANHATTEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08016-4119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-699-4131
Provider Business Mailing Address Fax Number:
609-386-2305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 E MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORESTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08057-2982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-235-1214
Provider Business Practice Location Address Fax Number:
856-727-4974
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKENFIELD
Authorized Official First Name:
COLLEEN
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT-CEO
Authorized Official Telephone Number:
609-699-4105

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 030305 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4466802 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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