Regency Hospital of Jackson, LLC

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

Legal business name

REGENCY HOSPITAL OF JACKSON, LLC

Practice address

969 Lakeland Dr
6TH Floor
Jackson, MS 39216-4606

Phone

(864) 255-1401

NPI assigned

Apr 26, 2006

Organization subpart

No

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

Authorized official

Name

Michael Tarvin

Title

Vice President

Phone

(717) 972-1100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 250161

Legal name

REGENCY HOSPITAL OF JACKSON, LLC

Certification status

Terminated Voluntary: merger or closure, Sep 30, 2006

Provider type (POS)

Hospital – Short-term

Participating since

Mar 29, 2006

Last certification

Mar 29, 2006

Beds

36

Ownership / control type

Private (for profit)

Facility address

969 Lakeland Drive, 6TH Floor
Jackson, MS 39216

Hospital certification: CCN 252012

Legal name

REGENCY HOSPITAL OF JACKSON, LLC - CLOSED

Certification status

Terminated Voluntary: merger or closure, Aug 2, 2016

Provider type (POS)

Hospital – Long-term

Participating since

Oct 1, 2006

Last certification

Aug 4, 2011

Beds

36

Ownership / control type

Private (for profit)

Facility address

969 Lakeland Drive, 6TH Floor
Jackson, MS 39216

Locations

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300924800000",
    "number": "1851357925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "address_2": "LEGAL DPT",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170554325",
            "telephone_number": "717-972-1100",
            "fax_number": "717-975-9981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAKELAND DR",
            "address_2": "6TH FLOOR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164606",
            "telephone_number": "864-255-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENCY HOSPITAL OF JACKSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2011-03-24",
        "status": "A",
        "authorized_official_last_name": "TARVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-972-1100"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Long Term Care Hospital in Jackson, MS
• Providers in Jackson, MS by specialty
• Long Term Care Hospital in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.