Regency Park Nursing and Rehabilitation Center of Jefferon
Organization Active NPI Skilled Nursing Facility · Jefferson, IA
NPI 1699824979 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1699824979
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 370034 (IA)
- Legal business name
- REGENCY PARK NURSING AND REHABILITATION CENTER OF JEFFERON
- Practice address
- 100 Ram Dr
Jefferson, IA 50129-2728 - Phone
- (515) 386-4107
- Fax
- (515) 386-2347
- NPI assigned
- Jan 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Matthew Allen Carpenter, NHA
- Title
- Administrator
- Phone
- (515) 386-4107
Corporate family (same tax ID) 5
National Provider Directory
- Tax ID family
- Centers for Long Term Care of Iowa
Locations
100 Ram Dr
Jefferson, IA 50129
Phone (515) 386-4107
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 370034 | IA | Yes |
Addresses
Primary practice location
100 Ram Dr
Jefferson, IA 50129-2728
Mailing address
100 Ram Dr
Jefferson, IA 50129-2728
Phone (515) 386-4107
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0650390 | Medicaid | IA |
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All providers in Jefferson, IA · Skilled Nursing Facility in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.