Healthcare Provider Details

I. General information

NPI: 1396847141
Provider Name (Legal Business Name): REGIS HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 NW 7TH ST STE 201
MIAMI FL
33125-3744
US

IV. Provider business mailing address

1250 NW 7TH ST STE 201
MIAMI FL
33125-3744
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-7600
  • Fax: 305-642-6898
Mailing address:
  • Phone: 305-642-7600
  • Fax: 305-642-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberHCC1046
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDRES CASTILLO DE LA TORRIENTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 305-642-7600