Provider Demographics
NPI:1336308501
Name:THE REGENERATION PROJECT LLC
Entity type:Organization
Organization Name:THE REGENERATION PROJECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO - GA
Authorized Official - Prefix:MR
Authorized Official - First Name:KWAME
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-802-4860
Mailing Address - Street 1:108 BYRD WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9195
Mailing Address - Country:US
Mailing Address - Phone:478-953-0330
Mailing Address - Fax:478-953-0368
Practice Address - Street 1:108 BYRD WAY STE 400
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9195
Practice Address - Country:US
Practice Address - Phone:443-802-4860
Practice Address - Fax:478-953-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD992400100Medicaid