Provider Demographics
NPI:1790067676
Name:REGAL SENIOR LIVING CORPORATION
Entity Type:Organization
Organization Name:REGAL SENIOR LIVING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-705-8021
Mailing Address - Street 1:1009 S CITRUS ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3403
Mailing Address - Country:US
Mailing Address - Phone:626-705-8021
Mailing Address - Fax:626-339-8902
Practice Address - Street 1:2929 S CITRUS ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-3411
Practice Address - Country:US
Practice Address - Phone:626-705-8021
Practice Address - Fax:626-339-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197607719310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility