Healthcare Provider Details

I. General information

NPI: 1699772152
Provider Name (Legal Business Name): REGENCY SENIOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 W BENDER RD
MILWAUKEE WI
53209-3801
US

IV. Provider business mailing address

1633 W BENDER RD
MILWAUKEE WI
53209-3801
US

V. Phone/Fax

Practice location:
  • Phone: 414-228-9440
  • Fax: 414-228-6320
Mailing address:
  • Phone: 414-228-9440
  • Fax: 414-228-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3185
License Number StateWI

VIII. Authorized Official

Name: MRS. CHRISTINA C ROOP
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 863-676-1512