=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679572960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. ANNS HOME FOR THE AGED CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2005
-----------------------------------------------------
Last Update Date | 02/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 198 OLD BERGEN RD
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07305-2622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-433-0950
-----------------------------------------------------
Fax | 201-433-6554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 198 OLD BERGEN RD
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07305-2622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-433-0950
-----------------------------------------------------
Fax | 201-433-6554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JANET MERLY-LIRANZO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-433-0950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 030904
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------