# SOUTH DENVER REGEN INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962024653
- **Authorized official:** SHAWN JOHONNESSON (PRESIDENT)
- **Authorized official phone:** (303) 738-0390

## Contact information

- **Practice address:** 8765 E ORCHARD RD STE 702, GREENWOOD VILLAGE, CO 80111-5009
- **Practice address phone:** (303) 738-0390
- **Practice address fax:** (866) 238-2721
- **Mailing address:** 8765 E ORCHARD RD STE 702, GREENWOOD VILLAGE, CO 80111-5009
- **Mailing address phone:** (303) 738-0390
- **Mailing address fax:** (866) 238-2721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/15/2020
- **Last updated:** 05/15/2020