Provider Demographics
NPI:1659609485
Name:REGENESIS ORGANZATION COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:REGENESIS ORGANZATION COMMUNITY HEALTH CENTER
Other - Org Name:REGENESIS COMMUNITY HEALTH CENTER DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-582-2817
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:864-582-2817
Mailing Address - Fax:
Practice Address - Street 1:550 S CHURCH STREET
Practice Address - Street 2:UNIT 2
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3306
Practice Address - Country:US
Practice Address - Phone:864-582-2817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENESIS ORGANZATION COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-07
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9355Medicaid