MEDICARE: REGAL HOME CARE, LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1114542933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGAL HOME CARE, LLC

Provider Business Mailing Address
First Line	:	2546 INDIAN TRL
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-8031
Country	:	US
Telephone Number	:	803-369-5803
Fax Number	:	800-253-1767

Provider Business Practice Location Address
First Line	:	2546 INDIAN TRL
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-8031
Country	:	US
Telephone Number	:	803-369-5803
Fax Number	:	800-253-1767

Authorized Official
Title or Position	:	OWNER / ADMINISTRATOR
Name	:	MR. MICHAEL REID
Credential	:	RN
Telephone Number	:	803-369-5803

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	06/09/2020

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