Provider Demographics
NPI:1588142541
Name:REGENCY IHS OF SAN ANTONIO LLC
Entity type:Organization
Organization Name:REGENCY IHS OF SAN ANTONIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-576-0694
Mailing Address - Street 1:5423 HAMILTON WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4344
Mailing Address - Country:US
Mailing Address - Phone:210-694-9494
Mailing Address - Fax:
Practice Address - Street 1:5423 HAMILTON WOLFE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-694-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9463Medicaid
TX103740Medicaid