Provider Demographics
NPI:1184854150
Name:REGENCY HEIGHTS OF DANIELSON, LLC
Entity Type:Organization
Organization Name:REGENCY HEIGHTS OF DANIELSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-386-0300
Mailing Address - Street 1:111 WESTCOTT RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2929
Mailing Address - Country:US
Mailing Address - Phone:860-774-9540
Mailing Address - Fax:860-774-9703
Practice Address - Street 1:111 WESTCOTT RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2929
Practice Address - Country:US
Practice Address - Phone:860-774-9540
Practice Address - Fax:860-774-9703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENCY HEALTHCARE MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-23
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT20454Medicaid
CT20454Medicaid