Provider Demographics
NPI:1780641092
Name:REGENCY HOME HEALTH LLC
Entity Type:Organization
Organization Name:REGENCY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-665-9800
Mailing Address - Street 1:8025 S WILLOW ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2311
Mailing Address - Country:US
Mailing Address - Phone:603-665-9800
Mailing Address - Fax:603-665-9805
Practice Address - Street 1:8025 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2311
Practice Address - Country:US
Practice Address - Phone:603-665-9800
Practice Address - Fax:603-665-9805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02919251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30592833Medicaid
NH30602571Medicaid
NH30592833Medicaid