1750354619 NPI number — REGIONCARE INC.

Table of content: (NPI 1750354619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750354619 NPI number — REGIONCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONCARE INC.
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:
REGIONCARE NURSING AGENCY
Provider Other Organization Name Type Code:
3
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:
1750354619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 COMMUNITY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11021-5510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-414-3900
Provider Business Mailing Address Fax Number:
516-414-3946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 STEWART AVE STE 145
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11530-4757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-266-5200
Provider Business Practice Location Address Fax Number:
516-266-5299
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUSACK
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SENIOR VICE PRESIDENT & CFO
Authorized Official Telephone Number:
516-321-6058

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0861L003 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01614520 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0861L003 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0861L . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0861L002 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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