Provider Demographics
NPI:1407393770
Name:REGIONAL WOMEN'S HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:REGIONAL WOMEN'S HEALTH GROUP, LLC
Other - Org Name:RWHG REVITALIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-669-6050
Mailing Address - Street 1:227 LAUREL RD
Mailing Address - Street 2:300
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-8303
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-651-0794
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:305
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-809-0909
Practice Address - Fax:856-809-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty