Provider Demographics
NPI:1508400474
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:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-594-0175
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:
Practice Address - Street 1:115 THOMAS ST STE C
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2147
Practice Address - Country:US
Practice Address - Phone:864-582-2411
Practice Address - Fax:864-256-4336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-04
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty