Provider Demographics
NPI:1356747521
Name:LUTHERAN SOCIAL MINISTRIES OF NEW JERSEY, INC.
Entity type:Organization
Organization Name:LUTHERAN SOCIAL MINISTRIES OF NEW JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, JD
Authorized Official - Phone:609-386-7171
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 1:3 MANHATTAN DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4119
Practice Address - Country:US
Practice Address - Phone:609-386-7171
Practice Address - Fax:609-386-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17LK15C320900000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3-49-1079Medicaid