LIFE AT LOURDES INC (NPI# 1063662187) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063662187 |
| Entity Type | Organization |
| Organization Name | LIFE AT LOURDES INC |
| Practice Address |
2475 Mcclellan Avenue Pennsauken NJ 08109 |
| Mailing Address |
2475 Mcclellan Ave Pennsauken NJ 08109-4683 |
| Practice Telephone | 8566753660 |
| Practice Fax Number | 8566753659 |
| Mailing Telephone | 8566753660 |
| Mailing Fax Number | 8566753659 |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2014-09-23 |
| Authorized Official Name | MS. JACQUELINE LAWSON (ELECTRONIC MEDICAL RECORDS LIASON) |
| Authorized Official Telephone | 8566753660 |
| Authorized Official Credential | RHIT, MLS |
| Is Organization Subpart | Y |
| Parent Organization Name | OUR LADY OF LOURDES HEALTH CARE SERVICES, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251T00000X | PACE Provider Organization | Agencies |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LIFE AT LOURDES INC. | 2475 Mcclellan Ave Bldg C, Pennsauken, NJ 08109-4683 |
| Street Address |
2475 MCCLELLAN AVENUE |
| City | PENNSAUKEN |
| State | NJ |
| Zip Code | 08109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306193958 | Marissa Weick | Social Worker | 2475 Mcclellan Avenue, Pennsauken, NJ 08109 | 2012-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730615543 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8301 Maple Ave, Pennsauken, NJ 08109 | 2017-05-11 |
| 1588085237 | Annie Nicole Fisher | Social Worker | 21 Merwit Court, Merchantville, NJ 08109 | 2013-12-26 |
| 1992013437 | Reliable Resources LLC | In Home Supportive Care | 211 West End Ave, Merchantville, NJ 08109 | 2010-09-17 |
| 1184942351 | Matt Lobel | Pharmacist | 14 South Cenre Street, Merchantville, NJ 08109 | 2010-05-12 |
| 1376712786 | Pinnacle Treatment Centers Nj IIi LLC | Clinic/Center | 7980 S Crescent Boulevard, Pennsauken, NJ 08109 | 2008-02-29 |
| 1043488851 | Karen Claytor | Physical Therapist | 2626 Mandall Ave, Pennsauken, NJ 08109 | 2008-02-14 |
| 1235334814 | Marian W Mote | Nurse Practitioner | Merchantville Pediatrics- A Division of Cha, 1 S. Centre Street, Suite 100, Merchantville, NJ 08109 | 2007-06-15 |
| 1386865905 | Enrico Doganiero | Pharmacist | 6338 Browning Rd, Pennsauken, NJ 08109 | 2007-05-01 |
| 1710008164 | Michele Jo Hain | Physical Therapist | 6981 N Park Drive, Suite 102, Pennsaukin, NJ 08109 | 2007-04-03 |
| 1902921562 | Occupational Health Centers of New Jersey, P.a. | Clinic/Center | 7204 North Park Drive, Pennsauken, NJ 08109 | 2007-03-20 |
| Find all providers in zip 08109 | ||||
| Taxonomy Code | 251T00000X |
| Grouping | Agencies |
| Classification | PACE Provider Organization |
| A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights. |
| Notes: Source: Centers for Medicare and Medicaid, PACE Fact Sheet http://www.cms.hhs.gov/PACE/Downloads/PACEFactSheet.pdf [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144861071 | Neighbours-inc | PACE Provider Organization | 231 Fawn Ridge Rd Apt 231, Hackettstown, NJ 07840-1635 | 2019-10-02 |
| 1306226196 | T.e.s.a. Transportation LLC | PACE Provider Organization | 11 King Hill Rd, High Bridge, NJ 08829-1625 | 2015-06-05 |
| 1598207417 | Atlanticare Health Services, Inc. | PACE Provider Organization | 1401 Atlantic Ave, Atlantic City, NJ 08401-7022 | 2016-11-09 |
| 1942678396 | Acutecare Health System | PACE Provider Organization | 1075 Stephenson Ave, Oceanport, NJ 07757 | 2015-09-02 |
| 1063819449 | Cp Counseling Services, LLC | PACE Provider Organization | 19 Winona Ave, Lincoln Park, NJ 07035-1711 | 2014-12-01 |
| 1306195391 | Lutheran Social Ministries of New Jersey | PACE Provider Organization | 377 Jersey Ave, Jersey City, NJ 07302-4393 | 2012-09-05 |
| 1033415740 | South Jersey Healthcare Life, Inc. | PACE Provider Organization | 2950 College Dr, Suite 1e, Vineland, NJ 08360-6933 | 2011-01-28 |
| 1194946053 | South Jersey Behavioral Health Resources Incorporated | PACE Provider Organization | 400 Market St, 1st Floor, Camden, NJ 08102-1526 | 2007-05-01 |
| City | PENNSAUKEN |
| Zip Code | 08109 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.