Provider Demographics
NPI:1538106380
Name:REGENCY ALBANY, LLC
Entity Type:Organization
Organization Name:REGENCY ALBANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:BART
Authorized Official - Last Name:BEDDOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-392-6189
Mailing Address - Street 1:805 19TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-4225
Mailing Address - Country:US
Mailing Address - Phone:541-926-6912
Mailing Address - Fax:541-926-6912
Practice Address - Street 1:805 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-4225
Practice Address - Country:US
Practice Address - Phone:541-926-6912
Practice Address - Fax:541-926-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
38-5220Medicare ID - Type Unspecified