Provider Demographics
NPI:1629439112
Name:LCEL AT MOORESTOWN AL
Entity Type:Organization
Organization Name:LCEL AT MOORESTOWN AL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-699-4131
Mailing Address - Street 1:3 MANHATTAN DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4119
Mailing Address - Country:US
Mailing Address - Phone:609-386-7171
Mailing Address - Fax:609-386-7191
Practice Address - Street 1:255 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2982
Practice Address - Country:US
Practice Address - Phone:856-235-1214
Practice Address - Fax:856-727-4974
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN HOME AT MOORESTOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0372731Medicaid