Provider Demographics
NPI:1508296914
Name:REGENCY ELDERLY CARE, INC.
Entity Type:Organization
Organization Name:REGENCY ELDERLY CARE, INC.
Other - Org Name:REGENCY ELDERLY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BENIROSE
Authorized Official - Middle Name:HARESCO
Authorized Official - Last Name:DEMETITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-427-2312
Mailing Address - Street 1:1511 MANGO TREE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-2607
Mailing Address - Country:US
Mailing Address - Phone:386-427-2312
Mailing Address - Fax:386-423-8487
Practice Address - Street 1:1511 MANGO TREE DR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-2607
Practice Address - Country:US
Practice Address - Phone:386-427-2312
Practice Address - Fax:386-423-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9390310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL9390OtherAHCA