Provider Demographics
NPI:1255756698
Name:REGAL HEALTHCARE SERVICE LLC.
Entity type:Organization
Organization Name:REGAL HEALTHCARE SERVICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINITWABE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-581-0878
Mailing Address - Street 1:1223 BANBERRY RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7701
Mailing Address - Country:US
Mailing Address - Phone:678-581-0878
Mailing Address - Fax:678-290-3141
Practice Address - Street 1:1223 BANBERRY RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7701
Practice Address - Country:US
Practice Address - Phone:678-581-0878
Practice Address - Fax:678-290-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00068830251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health