MEDICARE: ST. ANNS HOME FOR THE AGED CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	030904	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679572960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. ANNS HOME FOR THE AGED CORP

Provider Business Mailing Address
First Line	:	198 OLD BERGEN RD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2622
Country	:	US
Telephone Number	:	201-433-0950
Fax Number	:	201-433-6554

Provider Business Practice Location Address
First Line	:	198 OLD BERGEN RD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2622
Country	:	US
Telephone Number	:	201-433-0950
Fax Number	:	201-433-6554

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JANET MERLY-LIRANZO
Credential	:
Telephone Number	:	201-433-0950

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	02/09/2010

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