MEDICARE: REGENCY HEALTHCARE SERVICES

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	310400000X	Assisted Living Facility

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	:	1467650309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	1224 PEACOCK AVE
Second Line	:	SUITE 100A
City	:	COLUMBUS
State	:	GA
Zip	:	31906-6000
Country	:	US
Telephone Number	:	706-324-4001
Fax Number	:	706-324-0620

Provider Business Practice Location Address
First Line	:	1224 PEACOCK AVE
Second Line	:	SUITE 100A
City	:	COLUMBUS
State	:	GA
Zip	:	31906-6000
Country	:	US
Telephone Number	:	706-324-4001
Fax Number	:	706-324-0620

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. THEMETRICE L. NUNNALLY
Credential	:
Telephone Number	:	706-324-4001

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	09/28/2007

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Directions to “REGENCY HEALTHCARE SERVICES ” Practice Location

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