Provider Demographics
NPI:1003560285
Name:REJUVENATION HOUSE MEDI-SPA LLC
Entity Type:Organization
Organization Name:REJUVENATION HOUSE MEDI-SPA LLC
Other - Org Name:THE REJUVENATION HOUSE MEDI-SPA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:219-308-1589
Mailing Address - Street 1:144 E US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2117
Mailing Address - Country:US
Mailing Address - Phone:219-515-2667
Mailing Address - Fax:
Practice Address - Street 1:144 E US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2117
Practice Address - Country:US
Practice Address - Phone:219-515-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care