Provider Demographics
NPI:1992792923
Name:REGENCY CARE CENTER OF INDEPENDENCE, L.C.
Entity type:Organization
Organization Name:REGENCY CARE CENTER OF INDEPENDENCE, L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-257-2566
Mailing Address - Street 1:1800 S SWOPE DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1084
Mailing Address - Country:US
Mailing Address - Phone:816-257-2566
Mailing Address - Fax:816-257-4656
Practice Address - Street 1:1800 S SWOPE DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1084
Practice Address - Country:US
Practice Address - Phone:816-257-2566
Practice Address - Fax:816-257-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031185314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
265693Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER