Provider Demographics
NPI:1124212840
Name:MASONIC CHARITY FOUNDATION OF NEW JERSEY
Entity Type:Organization
Organization Name:MASONIC CHARITY FOUNDATION OF NEW JERSEY
Other - Org Name:ACACIA HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURSO
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:609-850-1089
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:609-589-4444
Mailing Address - Fax:609-589-4034
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:609-589-4444
Practice Address - Fax:609-589-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24104251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0157287Medicaid
NJ311569Medicare Oscar/Certification
NJ0157287Medicaid