1285186999 NPI number — REGENT BUNDLE OF RENO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285186999 NPI number — REGENT BUNDLE OF RENO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENT BUNDLE OF RENO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285186999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 WESTBROOK CORP CTR
Provider Second Line Business Mailing Address:
SUITE 440
Provider Business Mailing Address City Name:
WESTCHESTER
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60154-5752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-492-0531
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 WESTBROOK CORP CTR
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
WESTCHESTER
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60154-5752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-492-0531
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAU
Authorized Official First Name:
MATT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
708-492-0531

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)