# REGENCY CARE OF CLEMMONS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Regency Care of Clemmons
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225105273
- **Authorized official:** MR. STEVEN D. WOMACK CPA (MANAGING MEMBER)
- **Authorized official phone:** (828) 381-5360

## Contact information

- **Practice address:** 3905 CLEMMONS ROAD, CLEMMONS, NC 27012-8479
- **Practice address phone:** (336) 766-9158
- **Practice address fax:** (336) 766-8666
- **Mailing address:** PO BOX 1667, HICKORY, NC 28603-1667
- **Mailing address phone:** (828) 324-8898
- **Mailing address fax:** (828) 322-9598

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH0404 | NC | Yes |

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 04/22/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3435131 | — | NC |
| 01 | — | 923335 | FACILITY ID NUMBER | NC |
| 01 | — | NH0404 | STATE LICENSE | NC |