Provider Demographics
NPI:1427057918
Name:REGENCY HERITAGE NURSING & REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:REGENCY HERITAGE NURSING & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-730-9280
Mailing Address - Street 1:643 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4610
Mailing Address - Country:US
Mailing Address - Phone:732-730-9280
Mailing Address - Fax:732-730-9278
Practice Address - Street 1:380 DEMOTT LANE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2762
Practice Address - Country:US
Practice Address - Phone:732-873-2000
Practice Address - Fax:732-873-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061801314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18150/4499107Medicaid
NJ315367Medicare Oscar/Certification