Provider Demographics
NPI:1467650309
Name:REGENCY HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:REGENCY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THEMETRICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NUNNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-324-4001
Mailing Address - Street 1:1224 PEACOCK AVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-6000
Mailing Address - Country:US
Mailing Address - Phone:706-324-4001
Mailing Address - Fax:706-324-0620
Practice Address - Street 1:1224 PEACOCK AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-6000
Practice Address - Country:US
Practice Address - Phone:706-324-4001
Practice Address - Fax:706-324-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00684527AMedicaid