Healthcare Provider Details

I. General information

NPI: 1235997347
Provider Name (Legal Business Name): REGENCY PARK ASSISTED LIVING OPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 US HIGHWAY 441
EUSTIS FL
32726-6589
US

IV. Provider business mailing address

4200 NW 2ND AVE
MIAMI FL
33127-2802
US

V. Phone/Fax

Practice location:
  • Phone: 352-609-2040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MOSHE SIMON
Title or Position: MGR
Credential:
Phone: 847-471-1531