Basic Information
| Provider Information | |||||||||
| NPI: | 1235134024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIRTUA OUR LADY OF LOURDES HOSPITAL INC | ||||||||
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| OtherOrganizationName: | VIRTUA OUR LADY OF LOURDES HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 WEST STOW ROAD | ||||||||
| Address2: | SUITE 8 ATTN: CHRISTINE GORDON | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080533160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563550655 | ||||||||
| FaxNumber: | 8563550621 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 HADDON AVENUE | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081033101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565806330 | ||||||||
| FaxNumber: | 8566352400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | NESSEL | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP AND COO LOURDES | ||||||||
| AuthorizedOfficialTelephone: | 6098353056 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OUR LADY OF LOURDES HEALTH CARE SERVICES, INC. | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 10404 | NJ | Y | Hospitals | General Acute Care Hospital |
No ID Information.