Healthcare Provider Details

I. General information

NPI: 1780690339
Provider Name (Legal Business Name): REGENTS PARK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 VERDE TRL
BOCA RATON FL
33433-7702
US

IV. Provider business mailing address

6363 VERDE TRL
BOCA RATON FL
33433-7702
US

V. Phone/Fax

Practice location:
  • Phone: 561-483-9282
  • Fax: 561-226-1890
Mailing address:
  • Phone: 561-483-9282
  • Fax: 561-226-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1466096
License Number StateFL

VIII. Authorized Official

Name: MS. MARLENE HOLLIS LIEBERMAN
Title or Position: ADMINSTRATOR
Credential: MSW, NHA
Phone: 561-483-9282