Provider Demographics
NPI:1871841320
Name:REGENCY SENIOR DAY CARE, LLC
Entity Type:Organization
Organization Name:REGENCY SENIOR DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-588-2000
Mailing Address - Street 1:6625 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4416
Mailing Address - Country:US
Mailing Address - Phone:847-588-2000
Mailing Address - Fax:847-588-2003
Practice Address - Street 1:6625 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4416
Practice Address - Country:US
Practice Address - Phone:847-588-2000
Practice Address - Fax:847-588-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261774468261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care