Provider Demographics
NPI:1619658028
Name:REGEN OR
Entity Type:Organization
Organization Name:REGEN OR
Other - Org Name:ABSOLUTE WELLNESS CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-672-2974
Mailing Address - Street 1:730 SANDHILL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8962
Mailing Address - Country:US
Mailing Address - Phone:775-683-9026
Mailing Address - Fax:775-683-9017
Practice Address - Street 1:730 SANDHILL RD STE 120
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8962
Practice Address - Country:US
Practice Address - Phone:775-683-9026
Practice Address - Fax:775-683-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty