Provider Demographics
NPI:1285129080
Name:LINCOLN HEALTHCARE OF NEW JERSEY, LLC
Entity type:Organization
Organization Name:LINCOLN HEALTHCARE OF NEW JERSEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-924-7000
Mailing Address - Street 1:310 N DERBY LN UNIT 1243
Mailing Address - Street 2:
Mailing Address - City:NORTH SIOUX CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57049-7658
Mailing Address - Country:US
Mailing Address - Phone:712-490-9980
Mailing Address - Fax:
Practice Address - Street 1:309 FELLOWSHIP RD STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-924-7000
Practice Address - Fax:856-409-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHP0281000OtherHEALTH CARE SERVICES FIRM
NJ0665070Medicaid