Provider Demographics
NPI:1629726807
Name:REGINA PROVIDING CARE, INC.
Entity Type:Organization
Organization Name:REGINA PROVIDING CARE, INC.
Other - Org Name:REGINA PROVIDING CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-323-0055
Mailing Address - Street 1:800 VIRGINIA AVE STE 42
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5893
Mailing Address - Country:US
Mailing Address - Phone:772-323-0055
Mailing Address - Fax:772-323-0142
Practice Address - Street 1:800 VIRGINIA AVE STE 59B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5892
Practice Address - Country:US
Practice Address - Phone:772-323-0055
Practice Address - Fax:772-323-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities