Healthcare Provider Details

I. General information

NPI: 1972373793
Provider Name (Legal Business Name): REGENERATION RECOVERY AND REENTRY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10124 S BROADWAY STE 200B
LOS ANGELES CA
90003-4561
US

IV. Provider business mailing address

10124 S BROADWAY STE 200B
LOS ANGELES CA
90003-4561
US

V. Phone/Fax

Practice location:
  • Phone: 424-420-1441
  • Fax:
Mailing address:
  • Phone: 424-420-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMISHA MANN
Title or Position: CEO
Credential: SOCIAL WORKER
Phone: 424-420-1441