Provider Demographics
NPI:1063662187
Name:LIFE AT LOURDES INC
Entity Type:Organization
Organization Name:LIFE AT LOURDES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELECTRONIC MEDICAL RECORDS LIASON
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT, MLS
Authorized Official - Phone:856-675-3660
Mailing Address - Street 1:2475 MCCLELLAN AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4683
Mailing Address - Country:US
Mailing Address - Phone:856-675-3660
Mailing Address - Fax:856-675-3659
Practice Address - Street 1:2475 MCCLELLAN AVENUE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109
Practice Address - Country:US
Practice Address - Phone:856-675-3660
Practice Address - Fax:856-675-3659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR LADY OF LOURDES HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-25
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization