Provider Demographics
NPI:1548259393
Name:JEANNE JUGAN RESIDENCE
Entity type:Organization
Organization Name:JEANNE JUGAN RESIDENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:302-368-5886
Mailing Address - Street 1:185 SALEM CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2997
Mailing Address - Country:US
Mailing Address - Phone:302-368-5886
Mailing Address - Fax:302-292-1605
Practice Address - Street 1:185 SALEM CHURCH RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2942
Practice Address - Country:US
Practice Address - Phone:302-368-5886
Practice Address - Fax:302-292-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1133313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000125612Medicaid
DE000125612Medicaid