Provider Demographics
NPI:1386893337
Name:LIFE ST. FRANCIS CORPORATION
Entity type:Organization
Organization Name:LIFE ST. FRANCIS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:609-599-5475
Mailing Address - Street 1:7500 K JOHNSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2242
Mailing Address - Country:US
Mailing Address - Phone:609-599-5433
Mailing Address - Fax:
Practice Address - Street 1:7500 K JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2242
Practice Address - Country:US
Practice Address - Phone:609-599-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. FRANCIS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-15
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0169129Medicaid
H1234OtherMEDICARE H NUMBER