Healthcare Provider Details

I. General information

NPI: 1265509061
Provider Name (Legal Business Name): REGENCY MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 MADISON PIKE
INDEPENDENCE KY
41051
US

IV. Provider business mailing address

11725 MADISON PIKE
INDEPENDENCE KY
41051
US

V. Phone/Fax

Practice location:
  • Phone: 859-356-9294
  • Fax: 859-356-9535
Mailing address:
  • Phone: 859-356-9294
  • Fax: 859-356-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLI LYNN BAILEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-356-9294