REGENCY ELDERLY CARE, INC.

Contacts

Phone	+1 386-427-2312
Fax	3864238487

Authorized person

Name	MRS. BENIROSE HARESCO DEMETITA
Role	ADMINISTRATOR
Phone	3864272312

Taxonomy

Taxonomy Code	310400000X - Assisted Living Facility
License Number	AL9390
State	FL
Is Primary	Yes

Other Provider Identifiers

Issuer	AHCA
Number	AL9390
State	FL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	623000
Sponsor’s telephone number	3864272312
Plan sponsor’s address	1511 MANGO TREE DR, EDGEWATER, FL, 32132

Signature of

Role	Plan administrator
Date	2020-10-11
Name of individual signing	BENIROSE H DEMETITA
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	623000
Sponsor’s telephone number	3864272312
Plan sponsor’s address	1511 MANGO TREE DR, EDGEWATER, FL, 32132

Signature of

Role	Plan administrator
Date	2019-10-15
Name of individual signing	BENIROSE DEMETITA
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	623000
Sponsor’s telephone number	3864272312
Plan sponsor’s address	1511 MANGO TREE DR, EDGEWATER, FL, 32132

Signature of

Role	Plan administrator
Date	2018-07-12
Name of individual signing	BENIROSE H DEMETITA
Valid signature	Filed with authorized/valid electronic signature