Provider Demographics
NPI:1992248629
Name:REGENT PARK REHABILITATION AND HEALTHCARE
Entity type:Organization
Organization Name:REGENT PARK REHABILITATION AND HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHABILITATION
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:316-337-5450
Mailing Address - Street 1:13408 E TALLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-1766
Mailing Address - Country:US
Mailing Address - Phone:316-616-4924
Mailing Address - Fax:316-558-5259
Practice Address - Street 1:10604 E 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3706
Practice Address - Country:US
Practice Address - Phone:316-337-5450
Practice Address - Fax:316-558-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02419314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-02419OtherOT LICIENSE