Provider Demographics
NPI:1396847141
Name:REGIS HOUSE, INC.
Entity type:Organization
Organization Name:REGIS HOUSE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO DE LA TORRIENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-7600
Mailing Address - Street 1:1250 NW 7TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3744
Mailing Address - Country:US
Mailing Address - Phone:305-642-7600
Mailing Address - Fax:305-642-6898
Practice Address - Street 1:1250 NW 7TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3744
Practice Address - Country:US
Practice Address - Phone:305-642-7600
Practice Address - Fax:305-642-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC1046251V00000X, 251V00000X
261QM0855X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056393501Medicaid
FLK8708Medicare ID - Type UnspecifiedMEDICARE PART B