MEDICARE: REGIONAL HEALTH, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1457651093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	1328 E. EVERGREEN
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803
Country	:	US
Telephone Number	:	417-891-9939
Fax Number	:	417-891-9928

Provider Business Practice Location Address
First Line	:	222 S 1ST ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4504
Country	:	US
Telephone Number	:	479-464-0200
Fax Number	:	479-464-8098

Authorized Official
Title or Position	:	CFO
Name	:	MR. PHILLIP CODY LONG
Credential	:
Telephone Number	:	479-464-0200

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	11/07/2014

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