Provider Demographics
NPI:1154320331
Name:LAZMAN, INC.
Entity Type:Organization
Organization Name:LAZMAN, INC.
Other - Org Name:MANCHESTER MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:LENARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-663-4044
Mailing Address - Street 1:1770 TOBIAS AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-5803
Mailing Address - Country:US
Mailing Address - Phone:732-657-1800
Mailing Address - Fax:856-665-5708
Practice Address - Street 1:1114 WYNNWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3256
Practice Address - Country:US
Practice Address - Phone:856-663-4044
Practice Address - Fax:856-665-5708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061517314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4493702Medicaid
NJ315196Medicare ID - Type Unspecified
NJ4493702Medicaid