Healthcare Provider Details

I. General information

NPI: 1619270063
Provider Name (Legal Business Name): REGENERATION FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S MYRTLE AVE
CHINA GROVE NC
28023-2025
US

IV. Provider business mailing address

309 S MYRTLE AVE
CHINA GROVE NC
28023-2025
US

V. Phone/Fax

Practice location:
  • Phone: 704-201-4048
  • Fax:
Mailing address:
  • Phone: 704-201-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4248
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. JOE PARKER
Title or Position: PRESIDENT
Credential:
Phone: 704-201-4048