Provider Demographics
NPI:1306551569
Name:REGEN PLUS INC
Entity type:Organization
Organization Name:REGEN PLUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-290-5200
Mailing Address - Street 1:5562 W ARROWHEAD LAKES DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6293
Mailing Address - Country:US
Mailing Address - Phone:602-290-5200
Mailing Address - Fax:602-419-2210
Practice Address - Street 1:20229 N 67TH AVE STE C1A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6404
Practice Address - Country:US
Practice Address - Phone:602-595-7836
Practice Address - Fax:602-419-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1053742197Medicaid
AZ1770088205Medicaid