Provider Demographics
NPI:1275507998
Name:REGENCY PARK NURSING AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:REGENCY PARK NURSING AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WOODROW
Authorized Official - Last Name:SHACKLEFORD
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:330-682-2273
Mailing Address - Street 1:230 S CROWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1328
Mailing Address - Country:US
Mailing Address - Phone:330-682-2273
Mailing Address - Fax:330-682-5310
Practice Address - Street 1:230 S CROWN HILL RD
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1328
Practice Address - Country:US
Practice Address - Phone:330-682-2273
Practice Address - Fax:330-682-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5755314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2146752Medicaid
OH2146752Medicaid