Healthcare Provider Details

I. General information

NPI: 1669845707
Provider Name (Legal Business Name): REGENCY HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10467 93RD AVE N
MAPLE GROVE MN
55369-4112
US

IV. Provider business mailing address

10467 93RD AVE N
MAPLE GROVE MN
55369-4112
US

V. Phone/Fax

Practice location:
  • Phone: 651-488-4655
  • Fax: 651-488-4656
Mailing address:
  • Phone: 651-488-4655
  • Fax: 651-488-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEAN ANN JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 651-488-4655