=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073386116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGAL HEALTH AND WELLNESS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2023
-----------------------------------------------------
Last Update Date | 10/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9150 E 41ST TER STE 206
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64133-1448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-972-0791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9150 E 41ST TER STE 206
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64133-1448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-972-0791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ED/FOUNDER
-----------------------------------------------------
Name | DR. JUANITA SINGLETON
-----------------------------------------------------
Credential | PHD LPN CHW-C
-----------------------------------------------------
Telephone | 913-972-0791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------