Provider Demographics
NPI:1083884779
Name:PARK REGENCY OPERATOR LLC
Entity Type:Organization
Organization Name:PARK REGENCY OPERATOR LLC
Other - Org Name:COURTYARDS AT INVERRARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HORVATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-484-1969
Mailing Address - Street 1:2801 NW 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2509
Mailing Address - Country:US
Mailing Address - Phone:954-484-1960
Mailing Address - Fax:954-484-1994
Practice Address - Street 1:2801 NW 55TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-2509
Practice Address - Country:US
Practice Address - Phone:954-484-1960
Practice Address - Fax:954-484-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7249310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004033100Medicaid