Provider Demographics
NPI:1376225482
Name:REGENERATION BEHAVIORAL HEALTH CARE
Entity Type:Organization
Organization Name:REGENERATION BEHAVIORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VODY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-487-4222
Mailing Address - Street 1:2742 ALICE TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4103
Mailing Address - Country:US
Mailing Address - Phone:908-487-4222
Mailing Address - Fax:
Practice Address - Street 1:2742 ALICE TER
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4103
Practice Address - Country:US
Practice Address - Phone:908-487-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty