Provider Demographics
NPI:1043205859
Name:MASONIC CHARITY FOUNDATION OF NEW JERSEY
Entity Type:Organization
Organization Name:MASONIC CHARITY FOUNDATION OF NEW JERSEY
Other - Org Name:MASONIC HOME OF NEW JERSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEMANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA, RN
Authorized Official - Phone:609-239-3900
Mailing Address - Street 1:902 JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3814
Mailing Address - Country:US
Mailing Address - Phone:609-239-3900
Mailing Address - Fax:609-386-1199
Practice Address - Street 1:902 JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-3814
Practice Address - Country:US
Practice Address - Phone:609-239-3900
Practice Address - Fax:609-386-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ030306 / 103330314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4466101Medicaid
NJ4466101Medicaid