Provider Demographics
NPI:1578500922
Name:REGINA COMMUNITY NURSING CENTER
Entity Type:Organization
Organization Name:REGINA COMMUNITY NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-272-5600
Mailing Address - Street 1:550 E FORNANCE ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3536
Mailing Address - Country:US
Mailing Address - Phone:610-272-5600
Mailing Address - Fax:610-279-0529
Practice Address - Street 1:550 E FORNANCE ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3536
Practice Address - Country:US
Practice Address - Phone:610-272-5600
Practice Address - Fax:610-279-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANF-182002313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007457290004Medicaid
PA0005822000OtherINDEPENCE BLUE CROSS #
PA39-5483Medicare ID - Type Unspecified