Provider Demographics
NPI:1417498569
Name:THE REGENCY SENIOR CLUB
Entity Type:Organization
Organization Name:THE REGENCY SENIOR CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:WOZNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:520-209-1940
Mailing Address - Street 1:2972 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2813
Mailing Address - Country:US
Mailing Address - Phone:520-209-1940
Mailing Address - Fax:520-579-9954
Practice Address - Street 1:2972 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2813
Practice Address - Country:US
Practice Address - Phone:520-209-1940
Practice Address - Fax:520-579-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9994D385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ845737Medicaid
AZ78164Medicare PIN
AZS71441Medicare UPIN