Regency Terrace South, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3172 Issued in WI

Legal business name

REGENCY TERRACE SOUTH, INC

Doing business as

Hales Corners Care Center

Practice address

9449 W Forest Home Ave
Hales Corners, WI 53130-1611

Phone

(414) 529-6888

Fax

(414) 529-1271

NPI assigned

Jun 30, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Cynthia Berg

Title

Administrator

Phone

(414) 529-6888

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• HALES CORNERS CARE CENTER Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250035200000",
    "number": "1003813569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9449 W FOREST HOME AVE",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301611",
            "telephone_number": "414-529-6888",
            "fax_number": "414-529-1271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9449 W FOREST HOME AVE",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301611",
            "telephone_number": "414-529-6888",
            "fax_number": "414-529-1271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENCY TERRACE SOUTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2009-08-12",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "414-529-6888",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "3172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20176900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HALES CORNERS CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Hales Corners, WI
• Providers in Hales Corners, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.