Provider Demographics
NPI:1649498445
Name:REGENCY AT HOME CARE SERVICE
Entity type:Organization
Organization Name:REGENCY AT HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-647-1511
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:847-647-1511
Mailing Address - Fax:847-647-7746
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:847-647-1511
Practice Address - Fax:847-647-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001049251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherHUMANA