Provider Demographics
NPI:1437040706
Name:EXECUTIVE REGENERATIVE HEALTH
Entity type:Organization
Organization Name:EXECUTIVE REGENERATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:PERIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-730-6083
Mailing Address - Street 1:2052 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-6298
Mailing Address - Country:US
Mailing Address - Phone:559-730-6083
Mailing Address - Fax:
Practice Address - Street 1:3815 HIGHWAY 66 S STE 1
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-5197
Practice Address - Country:US
Practice Address - Phone:866-214-6774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center