=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730326828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGENCY HOSPICE OF NORTHWEST FLORIDA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2009
-----------------------------------------------------
Last Update Date | 01/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 BEVERLY PKWY STE 200
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32505-2814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-478-2695
-----------------------------------------------------
Fax | 850-478-9481
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4060
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28117-4060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-664-2876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF LICENSURE
-----------------------------------------------------
Name | MS. JANET COMBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-664-2876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 50370972
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------