Provider Demographics
NPI:1083963748
Name:REGAL HEART HOSPICE CORPORATION
Entity Type:Organization
Organization Name:REGAL HEART HOSPICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGENAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-854-0565
Mailing Address - Street 1:1032A COLLINGS AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1738
Mailing Address - Country:US
Mailing Address - Phone:856-854-0565
Mailing Address - Fax:856-854-0564
Practice Address - Street 1:1032 COLLINGS AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08107-1738
Practice Address - Country:US
Practice Address - Phone:856-854-0565
Practice Address - Fax:856-854-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-09
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based