Provider Demographics
NPI:1376533554
Name:LUTHERAN SOCIAL MINISTRIES AT CRANE'S MILL, INC.
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL MINISTRIES AT CRANE'S MILL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-386-7171
Mailing Address - Street 1:6 TERRI LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4905
Mailing Address - Country:US
Mailing Address - Phone:609-386-7171
Mailing Address - Fax:609-386-2305
Practice Address - Street 1:459 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7457
Practice Address - Country:US
Practice Address - Phone:973-276-6700
Practice Address - Fax:973-276-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ30A005310400000X
NJ306300314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315457Medicare Oscar/Certification