Provider Demographics
NPI:1164747929
Name:REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-582-2817
Mailing Address - Street 1:PO BOX 5158
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-5158
Mailing Address - Country:US
Mailing Address - Phone:864-582-2411
Mailing Address - Fax:864-582-7178
Practice Address - Street 1:750 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5348
Practice Address - Country:US
Practice Address - Phone:864-699-3283
Practice Address - Fax:864-699-3284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-05
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC108523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC710852Medicaid