Provider Demographics
NPI:1740598051
Name:REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Other - Org Name:REGENESIS HEALTH CARE PHARMACY #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-416-7933
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:864-416-7933
Mailing Address - Fax:864-416-7977
Practice Address - Street 1:1663 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9217
Practice Address - Country:US
Practice Address - Phone:864-416-7933
Practice Address - Fax:864-416-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC112713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20237OtherSOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION BOARD OF PHARMACY
2127707OtherPK