Provider Demographics
NPI:1689990723
Name:LUTHERAN SENIOR HEALTHCARE
Entity Type:Organization
Organization Name:LUTHERAN SENIOR HEALTHCARE
Other - Org Name:LUTHERAN SENIOR LIFE AT JERSEY CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKENSTAMM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:201-706-2091
Mailing Address - Street 1:377 JERSEY AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-706-2091
Mailing Address - Fax:201-706-2092
Practice Address - Street 1:377 JERSEY AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-706-2091
Practice Address - Fax:201-706-2092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SOCIAL MINISTRIES OF NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24396261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care