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General NPI Number Information
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NPI Number | 1164747929
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Entity Type | Organization
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Legal Business Name | REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 750 S CHURCH ST
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City | SPARTANBURG
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State | SC
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Zip | 29306-5348
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Country | US
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Telephone | 864-699-3283
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Fax | 864-699-3284
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Provider Business Mailing Address
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Address Line | PO BOX 5158
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City | SPARTANBURG
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State | SC
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Zip | 29304-5158
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Country | US
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Telephone | 864-582-2411
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Fax | 864-582-7178
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Authorized Official
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Title or Position | CEO
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Name | MR. MARLON HUNTER
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Credential |
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Telephone | 864-582-2817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10852
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License Number State | SC
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