Healthcare Provider Details

I. General information

NPI: 1003490327
Provider Name (Legal Business Name): REGENCY ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W WALLACE ST
ASHLEY MI
48806-9605
US

IV. Provider business mailing address

30700 TELEGRAPH RD STE 2504
BINGHAM FARMS MI
48025-4571
US

V. Phone/Fax

Practice location:
  • Phone: 989-847-2188
  • Fax:
Mailing address:
  • Phone: 248-593-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: FAHIM UDDIN
Title or Position: MEMBER
Credential:
Phone: 313-549-7708