Provider Demographics
NPI:1003490327
Name:REGENCY ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:REGENCY ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-549-7708
Mailing Address - Street 1:30700 TELEGRAPH RD STE 2504
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4571
Mailing Address - Country:US
Mailing Address - Phone:248-593-1990
Mailing Address - Fax:
Practice Address - Street 1:211 W WALLACE ST
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:MI
Practice Address - Zip Code:48806-9605
Practice Address - Country:US
Practice Address - Phone:989-847-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness