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General NPI Number Information
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NPI Number | 1992747224
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Entity Type | Organization
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Legal Business Name | REGENESIS HEALTH SERVICE INC.
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 582 CHERRY DR
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City | WACONIA
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State | MN
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Zip | 55387-4578
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Country | US
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Telephone | 888-431-9444
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Fax | 888-430-8776
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Provider Business Mailing Address
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Address Line | 582 CHERRY DR
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City | WACONIA
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State | MN
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Zip | 55387-4578
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Country | US
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Telephone | 888-431-9444
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Fax | 888-430-8776
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Authorized Official
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Title or Position | PRESIDENT / GENERAL MANAGER
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Name | MR. JOHN MARK BLOSSER
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Credential | BSW
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Telephone | 903-357-3391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1789
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License Number State | FL
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