Provider Demographics
NPI:1952429086
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 & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:REVEREND
Authorized Official - Phone:609-386-7171
Mailing Address - Street 1:6 TERRI LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4905
Mailing Address - Country:US
Mailing Address - Phone:609-386-7171
Mailing Address - Fax:609-386-7191
Practice Address - Street 1:323 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-2503
Practice Address - Country:US
Practice Address - Phone:609-392-1011
Practice Address - Fax:609-392-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ47A101310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8272301Medicaid