MEDICARE: REGINA PROVIDING CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	172V00000X	Community Health Worker
2	251E00000X	Home Health Agency
3	253Z00000X	In Home Supportive Care Agency
4	385H00000X	Respite Care
5	261QD1600X	Developmental Disabilities Clinic/Center

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629726807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGINA PROVIDING CARE, INC.

Provider Business Mailing Address
First Line	:	800 VIRGINIA AVE STE 42
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5893
Country	:	US
Telephone Number	:	772-323-0055
Fax Number	:	772-323-0142

Provider Business Practice Location Address
First Line	:	800 VIRGINIA AVE STE 42
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5893
Country	:	US
Telephone Number	:	772-323-0055
Fax Number	:	772-323-0142

Authorized Official
Title or Position	:	CEO/AGENCY OWNER
Name	:	REGINA R. DONALDSON
Credential	:
Telephone Number	:	772-323-0055

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	08/23/2024

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Directions to “REGINA PROVIDING CARE, INC. ” Practice Location

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