Provider Demographics
NPI:1780690339
Name:REGENTS PARK, INC.
Entity Type:Organization
Organization Name:REGENTS PARK, INC.
Other - Org Name:REGENTS PARK NURSING AND REHABILITAITON CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:HOLLIS
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, NHA
Authorized Official - Phone:561-483-9282
Mailing Address - Street 1:6363 VERDE TRL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7702
Mailing Address - Country:US
Mailing Address - Phone:561-483-9282
Mailing Address - Fax:561-226-1890
Practice Address - Street 1:6363 VERDE TRL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7702
Practice Address - Country:US
Practice Address - Phone:561-483-9282
Practice Address - Fax:561-226-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1466096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FL=========OtherTAX ID