Provider Demographics
NPI:1851524698
Name:SH CHARLOTTE REGENCY LEASING LLC
Entity Type:Organization
Organization Name:SH CHARLOTTE REGENCY LEASING LLC
Other - Org Name:REGENCY RETIREMENT VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-542-9449
Mailing Address - Street 1:9120 WILLOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8313
Mailing Address - Country:US
Mailing Address - Phone:704-542-9449
Mailing Address - Fax:704-542-0776
Practice Address - Street 1:9120 WILLOW RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8313
Practice Address - Country:US
Practice Address - Phone:704-542-9449
Practice Address - Fax:704-542-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-060-139310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility