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General NPI Number Information
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NPI Number | 1104954296
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Entity Type | Organization
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Legal Business Name | REGENCY SENIOR LIVING ALP
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3400 BRUSH HOLLOW RD
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City | WESTBURY
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State | NY
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Zip | 11590-1712
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Country | US
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Telephone | 516-334-3838
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Fax | 516-334-3866
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Provider Business Mailing Address
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Address Line | 3400 BRUSH HOLLOW RD
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City | WESTBURY
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State | NY
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Zip | 11590-1712
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Country | US
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Telephone | 516-334-3838
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Fax | 516-334-3866
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RAPHAEL WEISS
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Credential |
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Telephone | 516-334-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 400-F-295
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License Number State | NY
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