Provider Demographics
NPI:1952389272
Name:LITTLE SERVANT SISTERS - ST. JOSEPH'S HOME ASSISTED LIVING AND NURSING
Entity Type:Organization
Organization Name:LITTLE SERVANT SISTERS - ST. JOSEPH'S HOME ASSISTED LIVING AND NURSING
Other - Org Name:ST. JOSEPH'S SENIOR HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MDS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:732-750-0077
Mailing Address - Street 1:1-3 SAINT JOSEPH TERR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2611
Mailing Address - Country:US
Mailing Address - Phone:732-750-0077
Mailing Address - Fax:732-634-1811
Practice Address - Street 1:1-3 SAINT JOSEPH TER
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2611
Practice Address - Country:US
Practice Address - Phone:732-750-0077
Practice Address - Fax:732-634-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061223314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5353301Medicaid
NJ5353319Medicaid
NJ315318Medicare PIN