Provider Demographics
NPI:1538260039
Name:REGENTS PARK AT AVENTURA INC
Entity type:Organization
Organization Name:REGENTS PARK AT AVENTURA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESEL
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:305-932-6360
Mailing Address - Street 1:18905 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3208
Mailing Address - Country:US
Mailing Address - Phone:305-932-6360
Mailing Address - Fax:305-935-9278
Practice Address - Street 1:18905 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3208
Practice Address - Country:US
Practice Address - Phone:305-932-6360
Practice Address - Fax:305-935-9278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1384095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1MOtherBC FLORIDA
FLK1MOtherBC FLORIDA