Healthcare Provider Details

I. General information

NPI: 1427057918
Provider Name (Legal Business Name): REGENCY HERITAGE NURSING & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 DEMOTT LANE
SOMERSET NJ
08873-2762
US

IV. Provider business mailing address

643 CROSS ST
LAKEWOOD NJ
08701-4610
US

V. Phone/Fax

Practice location:
  • Phone: 732-873-2000
  • Fax: 732-873-2112
Mailing address:
  • Phone: 732-730-9280
  • Fax: 732-730-9278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061801
License Number StateNJ

VIII. Authorized Official

Name: AARON STEFANSKY
Title or Position: CONTROLLER
Credential:
Phone: 732-730-9280