Healthcare Provider Details

I. General information

NPI: 1104823764
Provider Name (Legal Business Name): REGENT CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 POLIFLY RD
HACKENSACK NJ
07601-3287
US

IV. Provider business mailing address

50 POLIFLY RD
HACKENSACK NJ
07601-3287
US

V. Phone/Fax

Practice location:
  • Phone: 201-646-1166
  • Fax: 201-487-3835
Mailing address:
  • Phone: 201-646-1166
  • Fax: 201-487-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060231
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02830
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerNJ
# 2
Identifier4465504
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. RICHARD PINELES
Title or Position: PRESIDENT
Credential:
Phone: 201-489-7400