Provider Demographics
NPI:1043713407
Name:LUKE'S PLACE, INC.
Entity type:Organization
Organization Name:LUKE'S PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-287-5855
Mailing Address - Street 1:543 W KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-2207
Mailing Address - Country:US
Mailing Address - Phone:856-287-1838
Mailing Address - Fax:856-546-7136
Practice Address - Street 1:323 E ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1501
Practice Address - Country:US
Practice Address - Phone:856-287-1838
Practice Address - Fax:856-546-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services