Provider Demographics
NPI:1063784924
Name:REGAL SENIOR CARE LLC
Entity type:Organization
Organization Name:REGAL SENIOR CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2543-996-7888
Mailing Address - Street 1:200 W HWY 6
Mailing Address - Street 2:STE 612
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3969
Mailing Address - Country:US
Mailing Address - Phone:254-399-6788
Mailing Address - Fax:254-399-6766
Practice Address - Street 1:1000 E AVENUE J
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-1211
Practice Address - Country:US
Practice Address - Phone:512-556-6267
Practice Address - Fax:512-556-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455951Medicare Oscar/Certification