Provider Demographics
NPI:1508996414
Name:MERION GARDENS ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:MERION GARDENS ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCOLO
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:856-299-0300
Mailing Address - Street 1:315 MERION AVE
Mailing Address - Street 2:
Mailing Address - City:CARNEYS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08069-3402
Mailing Address - Country:US
Mailing Address - Phone:856-299-0300
Mailing Address - Fax:856-299-0190
Practice Address - Street 1:315 MERION AVE
Practice Address - Street 2:
Practice Address - City:CARNEYS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08069-3402
Practice Address - Country:US
Practice Address - Phone:856-299-0300
Practice Address - Fax:856-299-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ75A001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9046402Medicaid