Provider Demographics
NPI:1881684066
Name:LUTHERAN HOME AT MOORESTOWN
Entity type:Organization
Organization Name:LUTHERAN HOME AT MOORESTOWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FRANKENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-699-4105
Mailing Address - Street 1:3 MANHATTEN 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:609-699-4131
Mailing Address - Fax:609-386-2305
Practice Address - Street 1:255 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2982
Practice Address - Country:US
Practice Address - Phone:856-235-1214
Practice Address - Fax:856-727-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ030305314000000X
NJ310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4466802Medicaid
NJ315201Medicare Oscar/Certification