Healthcare Provider Details

I. General information

NPI: 1811272537
Provider Name (Legal Business Name): REGENCY MANOR NURSING & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 MCCLELLAN ST
UTICA MI
48317-5277
US

IV. Provider business mailing address

30600 TELEGRAPH RD STE 2155
BINGHAM FARMS MI
48025-4588
US

V. Phone/Fax

Practice location:
  • Phone: 586-739-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMI

VIII. Authorized Official

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