Provider Demographics
NPI:1831691054
Name:REGAL COMMUNITY CONSULTANTS, LLC
Entity type:Organization
Organization Name:REGAL COMMUNITY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHASHA
Authorized Official - Middle Name:D'MY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CPRP, CBIS
Authorized Official - Phone:610-809-6495
Mailing Address - Street 1:5340 ANGORA TER STE 200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3114
Mailing Address - Country:US
Mailing Address - Phone:610-809-6495
Mailing Address - Fax:
Practice Address - Street 1:5340 ANGORA TER STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3114
Practice Address - Country:US
Practice Address - Phone:610-809-6495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-03
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251E00000X, 253Z00000X, 302R00000X, 305R00000X, 385H00000X
PA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No385H00000XRespite Care FacilityRespite Care