MEDICARE: REGENESIS HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265777908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENESIS HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 5158
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29304-5158
Country	:	US
Telephone Number	:	864-582-2817
Fax Number	:	864-582-2829

Provider Business Practice Location Address
First Line	:	220 IRBY ST
Second Line	:
City	:	WOODRUFF
State	:	SC
Zip	:	29388-1618
Country	:	US
Telephone Number	:	864-582-2411
Fax Number	:	864-670-9414

Authorized Official
Title or Position	:	CEO
Name	:	MR. MARLON HUNTER
Credential	:
Telephone Number	:	864-582-2817

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	08/26/2020

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