Provider Demographics
NPI:1710380670
Name:REGENCY CARE OF ARLINGTON LLC
Entity Type:Organization
Organization Name:REGENCY CARE OF ARLINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-381-5360
Mailing Address - Street 1:PO BOX 1667
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-1667
Mailing Address - Country:US
Mailing Address - Phone:828-324-8898
Mailing Address - Fax:828-322-9598
Practice Address - Street 1:1785 S HAYES ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2714
Practice Address - Country:US
Practice Address - Phone:703-920-5700
Practice Address - Fax:703-979-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2655314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710380670Medicaid
VANH2655OtherVA STATE FACILITY LICENSE NUMBER
VA1710380670Medicaid