Provider Demographics
NPI:1194852327
Name:HAZLET MANOR ASSOCIATES
Entity Type:Organization
Organization Name:HAZLET MANOR ASSOCIATES
Other - Org Name:REGENCY PARK NURSING CENTER
Other - Org Type:Doing Business As
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 STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-730-9280
Mailing Address - Fax:732-730-8407
Practice Address - Street 1:3325 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1552
Practice Address - Country:US
Practice Address - Phone:732-264-5800
Practice Address - Fax:732-264-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ55C000313M00000X
NJ061303314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4490207Medicaid
NJ4490207Medicaid