Provider Demographics
NPI:1679572960
Name:ST. ANNS HOME FOR THE AGED CORP
Entity Type:Organization
Organization Name:ST. ANNS HOME FOR THE AGED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MERLY-LIRANZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-433-0950
Mailing Address - Street 1:198 OLD BERGEN RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2622
Mailing Address - Country:US
Mailing Address - Phone:201-433-0950
Mailing Address - Fax:201-433-6554
Practice Address - Street 1:198 OLD BERGEN RD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2622
Practice Address - Country:US
Practice Address - Phone:201-433-0950
Practice Address - Fax:201-433-6554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ030904314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4479807Medicaid
31-5413Medicare ID - Type Unspecified