Provider Demographics
NPI:1093113425
Name:REGAL ASSISTED LIVING SERVICES, LLC
Entity Type:Organization
Organization Name:REGAL ASSISTED LIVING SERVICES, LLC
Other - Org Name:REGAL COTTAGE OF SOUTHLAND ACRES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAECI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTS FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-731-7630
Mailing Address - Street 1:7441 COFFEE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-3455
Mailing Address - Country:US
Mailing Address - Phone:713-731-7630
Mailing Address - Fax:713-731-7632
Practice Address - Street 1:7441 COFFEE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-3455
Practice Address - Country:US
Practice Address - Phone:713-731-7630
Practice Address - Fax:713-731-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPPLYING310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility