Provider Demographics
NPI:1588866420
Name:REGENCY ADULT HOME CARE
Entity type:Organization
Organization Name:REGENCY ADULT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OTILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-375-1670
Mailing Address - Street 1:901 W PORT ROYALE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5298
Mailing Address - Country:US
Mailing Address - Phone:602-375-1670
Mailing Address - Fax:602-375-1396
Practice Address - Street 1:901 W PORT ROYALE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-5298
Practice Address - Country:US
Practice Address - Phone:602-375-1670
Practice Address - Fax:602-375-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2315311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home