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General NPI Number Information
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NPI Number | 1003490327
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Entity Type | Organization
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Legal Business Name | REGENCY ASSISTED LIVING LLC
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 211 W WALLACE ST
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City | ASHLEY
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State | MI
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Zip | 48806-9605
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Country | US
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Telephone | 989-847-2188
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Fax |
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Provider Business Mailing Address
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Address Line | 30700 TELEGRAPH RD STE 2504
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-4571
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Country | US
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Telephone | 248-593-1990
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | FAHIM UDDIN
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Credential |
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Telephone | 313-549-7708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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