Provider Demographics
NPI:1376588715
Name:THE REJUVENATION CENTER OF CHANDLER
Entity Type:Organization
Organization Name:THE REJUVENATION CENTER OF CHANDLER
Other - Org Name:THE REJUVENATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-391-2635
Mailing Address - Street 1:1910 S 72ND ST
Mailing Address - Street 2:STE 302
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1734
Mailing Address - Country:US
Mailing Address - Phone:402-391-2635
Mailing Address - Fax:402-391-0326
Practice Address - Street 1:1445 W CHANDLER BLVD
Practice Address - Street 2:BLDG A
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6130
Practice Address - Country:US
Practice Address - Phone:480-899-4878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty