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General NPI Number Information
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NPI Number | 1124212840
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Entity Type | Organization
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Legal Business Name | MASONIC CHARITY FOUNDATION OF NEW JERSEY
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 902 JACKSONVILLE RD
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City | BURLINGTON
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State | NJ
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Zip | 08016-3814
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Country | US
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Telephone | 609-589-4444
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Fax | 609-589-4034
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Provider Business Mailing Address
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Address Line | 902 JACKSONVILLE RD
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City | BURLINGTON
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State | NJ
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Zip | 08016-3814
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Country | US
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Telephone | 609-589-4444
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Fax | 609-589-4034
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ANDA DURSO
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Credential | LNHA
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Telephone | 609-850-1089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 24104
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License Number State | NJ
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