Healthcare Provider Details

I. General information

NPI: 1285129080
Provider Name (Legal Business Name): LINCOLN HEALTHCARE OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 FELLOWSHIP RD STE 100
MOUNT LAUREL NJ
08054
US

IV. Provider business mailing address

310 N DERBY LN UNIT 1243
NORTH SIOUX CITY SD
57049-7658
US

V. Phone/Fax

Practice location:
  • Phone: 856-924-7000
  • Fax: 856-409-5064
Mailing address:
  • Phone: 712-490-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierHP0281000
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHEALTH CARE SERVICES FIRM
# 2
Identifier0665070
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. RODNEY A LEACH
Title or Position: CEO
Credential:
Phone: 856-924-7000