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General NPI Number Information
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NPI Number | 1407390768
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Entity Type | Organization
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Legal Business Name | REGAL LEGACY GROUP LLC
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 5767 NC HIGHWAY 135
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City | STONEVILLE
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State | NC
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Zip | 27048-8477
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Country | US
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Telephone | 336-587-4603
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Fax |
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Provider Business Mailing Address
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Address Line | 185 CRUTCHFIELD RD
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City | REIDSVILLE
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State | NC
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Zip | 27320-8261
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Country | US
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Telephone | 336-587-4603
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SAGE LAWSON
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Credential |
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Telephone | 336-394-6423
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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 |
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License Number State |
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