Provider Demographics
NPI:1366873028
Name:REGAL ADULT DAY SERVICES, LLC
Entity type:Organization
Organization Name:REGAL ADULT DAY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, KDL ENTERPRISES, INC.
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-781-7906
Mailing Address - Street 1:3924-26 MAIN ST.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-2991
Mailing Address - Country:US
Mailing Address - Phone:219-413-5244
Mailing Address - Fax:219-413-5245
Practice Address - Street 1:3924 MAIN ST # 26
Practice Address - Street 2:SUITE 102
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-2990
Practice Address - Country:US
Practice Address - Phone:219-413-5244
Practice Address - Fax:219-413-5245
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KDL ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care