Provider Demographics
NPI:1316298276
Name:LIFE CHOICE HOSPICE OF SOUTHERN NEW JERSEY LLC
Entity type:Organization
Organization Name:LIFE CHOICE HOSPICE OF SOUTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-781-7317
Mailing Address - Street 1:200 DRYDEN RD E
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1044
Mailing Address - Country:US
Mailing Address - Phone:800-557-7570
Mailing Address - Fax:800-865-0486
Practice Address - Street 1:1415 HOOPER AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2800
Practice Address - Country:US
Practice Address - Phone:866-411-9555
Practice Address - Fax:723-341-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311562Medicare Oscar/Certification