Provider Demographics
NPI:1366978538
Name:REGENCY MEMORY CARE
Entity type:Organization
Organization Name:REGENCY MEMORY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-381-5360
Mailing Address - Street 1:130 STERLING WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:859-520-5111
Mailing Address - Fax:859-520-5112
Practice Address - Street 1:130 STERLING WAY
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353
Practice Address - Country:US
Practice Address - Phone:859-520-5111
Practice Address - Fax:859-520-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100468310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY100468OtherPERSONAL CARE HOME LICENSE NUMBER