Provider Demographics
NPI:1386233898
Name:REGENCY RETIREMENT LIVING INC
Entity type:Organization
Organization Name:REGENCY RETIREMENT LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-332-0938
Mailing Address - Street 1:220 W BEEBE AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-1358
Mailing Address - Country:US
Mailing Address - Phone:605-734-0404
Mailing Address - Fax:605-734-0566
Practice Address - Street 1:220 W BEEBE AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-1358
Practice Address - Country:US
Practice Address - Phone:605-734-0404
Practice Address - Fax:605-734-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility