Provider Demographics
NPI:1245226299
Name:REGENCY CARE OF MOUNT STERLING LLC
Entity type:Organization
Organization Name:REGENCY CARE OF MOUNT STERLING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-381-5360
Mailing Address - Street 1:PO BOX 1667
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-1667
Mailing Address - Country:US
Mailing Address - Phone:828-324-8898
Mailing Address - Fax:828-322-9598
Practice Address - Street 1:125 STERLING WAY
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1172
Practice Address - Country:US
Practice Address - Phone:859-498-3343
Practice Address - Fax:859-498-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750016261QA0600X
KY100468314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY100468OtherSTATE LICENSE
KY7100140000Medicaid
KY185242Medicare Oscar/Certification
185242Medicare Oscar/Certification