Healthcare Provider Details

I. General information

NPI: 1407865041
Provider Name (Legal Business Name): REGENCY NURSING CENTER PARTNERS OF WHARTON, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SUNNY LN
WHARTON TX
77488-3300
US

IV. Provider business mailing address

1220 SUNNY LN
WHARTON TX
77488-3300
US

V. Phone/Fax

Practice location:
  • Phone: 979-532-5020
  • Fax: 979-532-8853
Mailing address:
  • Phone: 979-532-5020
  • Fax: 979-532-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number118478
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5806140001
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number675361
License Number StateTX

VIII. Authorized Official

Name: MR. HEBER S. LACERDA
Title or Position: PRES/CEO
Credential:
Phone: 361-576-0694