Regenerise Health LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REGENERISE HEALTH LLC

Practice address

300 Church St
Wallingford, CT 06492-2253

Phone

(860) 994-7339

NPI assigned

Mar 24, 2023

Last updated

Oct 20, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Authurine Hannam-Davis, NPNPI 1891241873

Title

Family Nurse Practitioner

Phone

(860) 994-7339

Specialties & licenses 2

Addresses

Other names 1

• REGENERISE HEALTH LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Tax ID family

Regenerise Health LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Regenerise Health LLC

  • Health Service Clinic/Center
  • Yalesville, CT
  • NPI 1154016160
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Authurine Hannam-Davis, A.P.R.N

  • Family Nurse Practitioner
  • Wallingford, CT
  • NPI 1891241873
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729382400000",
    "number": "1083317390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CHURCH ST STE 103",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922253",
            "telephone_number": "860-994-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CHURCH ST",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922253",
            "telephone_number": "860-994-7339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERISE HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-24",
        "last_updated": "2024-10-20",
        "certification_date": "2024-10-20",
        "status": "A",
        "authorized_official_last_name": "HANNAM-DAVIS",
        "authorized_official_first_name": "AUTHURINE",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "860-994-7339",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REGENERISE HEALTH LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "REGENERISE HEALTH LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Recovercare, LLC
• Sandeep Reddy, MD
• John W Redmond, MD
• Eva M. Reed, COTA/L
• Regency House of Wallingford, Inc. (Regency House Nursing and Rehabilitation Center)
• Michael Reiss, M.A., MFT
• Elizabeth R Renker, APRN
• Resilience Counseling Services
• Keona Reyes, OT
• Michael Reynolds, LCSW

• Clinic/Center in Wallingford, CT
• Providers in Wallingford, CT by specialty
• Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.