1124553029 NPI number — REGENERATION HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124553029 NPI number — REGENERATION HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENERATION HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124553029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21515 HAWTHORNE BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90503-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-330-6054
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21515 HAWTHORNE BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90503-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-330-6054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
RYAN
Authorized Official Title or Position:
CHIEF HEALTH OFFICER
Authorized Official Telephone Number:
206-330-6054

Provider Taxonomy Codes

  • Taxonomy code: 111NN1001X , with the licence number:  14560 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)