MEDICARE: REGENCY SENIOR SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	314000000X	Skilled Nursing Facility	3185	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699772152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY SENIOR SERVICES LLC

Provider Business Mailing Address
First Line	:	1633 W BENDER RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-3801
Country	:	US
Telephone Number	:	414-228-9440
Fax Number	:	414-228-6320

Provider Business Practice Location Address
First Line	:	1633 W BENDER RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-3801
Country	:	US
Telephone Number	:	414-228-9440
Fax Number	:	414-228-6320

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	MRS. CHRISTINA C ROOP
Credential	:
Telephone Number	:	863-676-1512

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/20/2008

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