Provider Demographics
NPI:1336209824
Name:DE LA SALLE HALL INC
Entity Type:Organization
Organization Name:DE LA SALLE HALL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:732-530-9470
Mailing Address - Street 1:810 NEWMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738
Mailing Address - Country:US
Mailing Address - Phone:732-530-9470
Mailing Address - Fax:732-530-8072
Practice Address - Street 1:810 NEWMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738
Practice Address - Country:US
Practice Address - Phone:732-530-9470
Practice Address - Fax:732-530-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7173903Medicaid
NJ315374Medicare ID - Type Unspecified