Healthcare Provider Details

I. General information

NPI: 1811822042
Provider Name (Legal Business Name): REGENERATIVE HEALTH SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37304 LIGHTHOUSE RD UNIT 12
SELBYVILLE DE
19975-4454
US

IV. Provider business mailing address

37304 LIGHTHOUSE RD UNIT 12
SELBYVILLE DE
19975-4454
US

V. Phone/Fax

Practice location:
  • Phone: 703-851-3390
  • Fax: 888-543-4233
Mailing address:
  • Phone: 703-851-3390
  • Fax: 888-543-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY A JOHNSON
Title or Position: OWNER
Credential:
Phone: 703-851-3390