Provider Demographics
NPI:1922696277
Name:REGENERATIVE HEALTH 360 LLC
Entity Type:Organization
Organization Name:REGENERATIVE HEALTH 360 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-464-7985
Mailing Address - Street 1:1650 SKYLYN DR STE 420
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1047
Mailing Address - Country:US
Mailing Address - Phone:864-464-7985
Mailing Address - Fax:
Practice Address - Street 1:418 TOWN PARK BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3492
Practice Address - Country:US
Practice Address - Phone:706-222-5155
Practice Address - Fax:762-222-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty