Provider Demographics
NPI:1245062439
Name:REGIS LEGACY LLC
Entity type:Organization
Organization Name:REGIS LEGACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWASEGUN
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:OLUDIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-613-4377
Mailing Address - Street 1:21310 PLUM GATE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1425
Mailing Address - Country:US
Mailing Address - Phone:832-613-4377
Mailing Address - Fax:
Practice Address - Street 1:21310 PLUM GATE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1425
Practice Address - Country:US
Practice Address - Phone:832-613-4377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities