Provider Demographics
NPI:1699772152
Name:REGENCY SENIOR SERVICES LLC
Entity type:Organization
Organization Name:REGENCY SENIOR SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-676-1512
Mailing Address - Street 1:1633 W BENDER RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3801
Mailing Address - Country:US
Mailing Address - Phone:414-228-9440
Mailing Address - Fax:414-228-6320
Practice Address - Street 1:1633 W BENDER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3801
Practice Address - Country:US
Practice Address - Phone:414-228-9440
Practice Address - Fax:414-228-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3185314000000X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20182800Medicaid
WI20182800Medicaid
WI525323Medicare ID - Type Unspecified