Healthcare Provider Details

I. General information

NPI: 1184854150
Provider Name (Legal Business Name): REGENCY HEIGHTS OF DANIELSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WESTCOTT RD
DANIELSON CT
06239-2929
US

IV. Provider business mailing address

111 WESTCOTT RD
DANIELSON CT
06239-2929
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-9540
  • Fax: 860-774-9703
Mailing address:
  • Phone: 860-774-9540
  • Fax: 860-774-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier20454
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer

VIII. Authorized Official

Name: MR. MOHAMMAD A QAZI
Title or Position: CEO/PRESIDENT
Credential:
Phone: 248-386-0300