Provider Demographics
NPI:1245266915
Name:REGINA HEALTH CENTER
Entity type:Organization
Organization Name:REGINA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLANNERY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:330-659-4161
Mailing Address - Street 1:5232 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9481
Mailing Address - Country:US
Mailing Address - Phone:330-659-4161
Mailing Address - Fax:330-659-5113
Practice Address - Street 1:5232 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9481
Practice Address - Country:US
Practice Address - Phone:330-659-4161
Practice Address - Fax:330-659-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4719314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000232272OtherANTHEM BLUE CROSS BLUE SC
OH0933806Medicaid
OH000000232272OtherANTHEM BLUE CROSS BLUE SC