Healthcare Provider Details

I. General information

NPI: 1871841320
Provider Name (Legal Business Name): REGENCY SENIOR DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 N MILWAUKEE AVE
NILES IL
60714-4416
US

IV. Provider business mailing address

6625 N MILWAUKEE AVE
NILES IL
60714-4416
US

V. Phone/Fax

Practice location:
  • Phone: 847-588-2000
  • Fax: 847-588-2003
Mailing address:
  • Phone: 847-588-2000
  • Fax: 847-588-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number261774468
License Number StateIL

VIII. Authorized Official

Name: MRS. DIANA MCCLINTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 847-588-2000