Provider Demographics
NPI:1083045124
Name:REGINA SENIOR LIVING
Entity Type:Organization
Organization Name:REGINA SENIOR LIVING
Other - Org Name:REGINA ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-480-4333
Mailing Address - Street 1:1175 NININGER RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1056
Mailing Address - Country:US
Mailing Address - Phone:651-480-4333
Mailing Address - Fax:651-404-1286
Practice Address - Street 1:1175 NININGER RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1056
Practice Address - Country:US
Practice Address - Phone:651-480-4333
Practice Address - Fax:651-404-1286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEDICTINE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-27
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility