# REGENCY GRANDE NURSING AND REHABILITATION CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699802835
- **Authorized official:** AARON STEFANSKY (CONTROLLER)
- **Authorized official phone:** (732) 730-9280

## Contact information

- **Practice address:** 65 N SUSSEX ST, DOVER, NJ 07801
- **Practice address phone:** (973) 361-5200
- **Practice address fax:** (973) 361-0375
- **Mailing address:** 643 CROSS ST, LAKEWOOD, NJ 08701
- **Mailing address phone:** (732) 730-9280
- **Mailing address fax:** (732) 730-8407

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 603300 | NJ | — |
| 314000000X | Skilled Nursing Facility | 061423 | NJ | Yes |

## Other

- **Enumeration date:** 02/27/2007
- **Last updated:** 09/29/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4491807 | — | NJ |