Provider Demographics
NPI:1588288534
Name:REGAL TOWERS BLDG C , LLC DBA IMPERIAL SENIOR SUITES
Entity type:Organization
Organization Name:REGAL TOWERS BLDG C , LLC DBA IMPERIAL SENIOR SUITES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-200-0180
Mailing Address - Street 1:27600 FRANKLIN RD OFC
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2360
Mailing Address - Country:US
Mailing Address - Phone:248-200-0180
Mailing Address - Fax:248-200-0182
Practice Address - Street 1:27600 FRANKLIN RD OFC
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2360
Practice Address - Country:US
Practice Address - Phone:248-200-0180
Practice Address - Fax:248-200-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility