Provider Demographics
NPI:1922015122
Name:SJF CCRC, INC
Entity Type:Organization
Organization Name:SJF CCRC, INC
Other - Org Name:LIONS GATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-679-2211
Mailing Address - Street 1:1110 LAUREL OAK RD
Mailing Address - Street 2:EXECUTIVE OFFICES
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4344
Mailing Address - Country:US
Mailing Address - Phone:856-679-2210
Mailing Address - Fax:856-667-5042
Practice Address - Street 1:1100 LAUREL OAK RD
Practice Address - Street 2:LIONS GATE HEALTH CENTER
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4363
Practice Address - Country:US
Practice Address - Phone:856-679-2270
Practice Address - Fax:856-667-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ04A003310400000X
311500000X
NJ04002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0124737Medicaid
NJ315499Medicare Oscar/Certification