MEDICARE: REGINA'S HOME, 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1528920741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGINA'S HOME, INC.

Provider Business Mailing Address
First Line	:	139 TAYLOR ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-1712
Country	:	US
Telephone Number	:	313-268-5204
Fax Number	:	313-861-0644

Provider Business Practice Location Address
First Line	:	139 TAYLOR ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-1712
Country	:	US
Telephone Number	:	313-268-5204
Fax Number	:	313-861-0644

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ELLEN LEWIS
Credential	:
Telephone Number	:	313-268-5204

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	11/25/2025

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