Healthcare Provider Details

I. General information

NPI: 1366873028
Provider Name (Legal Business Name): REGAL ADULT DAY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 MAIN ST # 26 SUITE 102
EAST CHICAGO IN
46312-2990
US

IV. Provider business mailing address

3924-26 MAIN ST. SUITE 102
EAST CHICAGO IN
46312-2991
US

V. Phone/Fax

Practice location:
  • Phone: 219-413-5244
  • Fax: 219-413-5245
Mailing address:
  • Phone: 219-413-5244
  • Fax: 219-413-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KIMBERLY J. EDWARDS
Title or Position: PRESIDENT, KDL ENTERPRISES, INC.
Credential:
Phone: 219-781-7906