Provider Demographics
NPI:1205415882
Name:REGENERATE GHODS, INC
Entity Type:Organization
Organization Name:REGENERATE GHODS, INC
Other - Org Name:REGENERATE THE FUTURE OF MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-879-7167
Mailing Address - Street 1:8200 WILSHIRE BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2328
Mailing Address - Country:US
Mailing Address - Phone:323-438-2650
Mailing Address - Fax:
Practice Address - Street 1:6310 SAN VICENTE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5458
Practice Address - Country:US
Practice Address - Phone:323-438-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center