Provider Demographics
NPI:1477506970
Name:HUNTSVILLE SENIOR SERVICES, LLC
Entity Type:Organization
Organization Name:HUNTSVILLE SENIOR SERVICES, LLC
Other - Org Name:REGENCY HEALTH CARE AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:256-852-0033
Mailing Address - Street 1:2004 MAX LUTHER DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-3800
Mailing Address - Country:US
Mailing Address - Phone:256-852-0033
Mailing Address - Fax:256-859-7700
Practice Address - Street 1:2004 MAX LUTHER DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3800
Practice Address - Country:US
Practice Address - Phone:256-852-0033
Practice Address - Fax:256-859-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN4505314000000X
AL126103140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL475809OSMedicaid
AL475809OSMedicaid