Provider Demographics
NPI:1124210661
Name:REGAL HEIGHTS REHAB & HEALTH CARE CENTER ADULT DAY HEALTH CARE
Entity Type:Organization
Organization Name:REGAL HEIGHTS REHAB & HEALTH CARE CENTER ADULT DAY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-662-5100
Mailing Address - Street 1:7005 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3970
Mailing Address - Country:US
Mailing Address - Phone:718-662-5100
Mailing Address - Fax:718-565-9700
Practice Address - Street 1:7005 35TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3970
Practice Address - Country:US
Practice Address - Phone:718-662-5100
Practice Address - Fax:718-565-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003397N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02491463Medicaid