MEDICARE: REGENCY VILLAGE, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	3409	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003819954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY VILLAGE, LTD

Provider Business Mailing Address
First Line	:	PO BOX 541084
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45254-1084
Country	:	US
Telephone Number	:	513-474-6200
Fax Number	:	513-388-3000

Provider Business Practice Location Address
First Line	:	6550 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1065
Country	:	US
Telephone Number	:	513-522-5516
Fax Number	:	513-728-2216

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	YONI WAGSCHAL
Credential	:
Telephone Number	:	513-474-6200

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

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