Provider Demographics
NPI:1346480738
Name:REJUVENATE REHABILITATION CENTER
Entity Type:Organization
Organization Name:REJUVENATE REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VALENTINE
Authorized Official - Middle Name:DIVINA
Authorized Official - Last Name:VILLARBA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:201-334-6991
Mailing Address - Street 1:300 GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4398
Mailing Address - Country:US
Mailing Address - Phone:201-408-5525
Mailing Address - Fax:201-408-5526
Practice Address - Street 1:300 GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4398
Practice Address - Country:US
Practice Address - Phone:201-408-5525
Practice Address - Fax:201-408-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01187800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ156162Medicare PIN