Provider Demographics
NPI:1326423047
Name:REGIONS HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:REGIONS HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:OBIAGERI
Authorized Official - Last Name:ORIZU
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:305-305-3545
Mailing Address - Street 1:160 NW 176TH ST STE 302-3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5023
Mailing Address - Country:US
Mailing Address - Phone:305-305-3545
Mailing Address - Fax:954-435-2363
Practice Address - Street 1:160 NW 176TH ST STE 302-3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-5023
Practice Address - Country:US
Practice Address - Phone:305-305-3545
Practice Address - Fax:954-435-2363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONS HEALTHCARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003239100251C00000X
FL003410000251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003410000Medicaid
FL003239100Medicaid