MEDICARE: REGENCY COMMUNITY SERVICES, INC.

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	261QD1600X	Developmental Disabilities Clinic/Center	84V	TX

General Provider Information

NPI Number	:	1447462197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY COMMUNITY SERVICES, INC.

Provider Business Mailing Address
First Line	:	2391 NE LOOP 410 STE 403
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5675
Country	:	US
Telephone Number	:	210-403-9372
Fax Number	:	210-495-1538

Provider Business Practice Location Address
First Line	:	2391 NE LOOP 410 STE 403
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5675
Country	:	US
Telephone Number	:	210-403-9372
Fax Number	:	210-495-1538

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DARIAN SHANE WEST
Credential	:	BSW
Telephone Number	:	210-403-9372

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	10/20/2010

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