Provider Demographics
NPI:1437719879
Name:REJUVENATING COMPREHENSIVE SERVICES
Entity Type:Organization
Organization Name:REJUVENATING COMPREHENSIVE SERVICES
Other - Org Name:REJUVENATING COMPREHENSIVE SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:
Authorized Official - Last Name:FINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-504-4706
Mailing Address - Street 1:2100 E FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-1022
Mailing Address - Country:US
Mailing Address - Phone:314-504-4706
Mailing Address - Fax:314-659-8007
Practice Address - Street 1:9231 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1422
Practice Address - Country:US
Practice Address - Phone:314-279-1444
Practice Address - Fax:314-801-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588009344OtherPERSONAL NPI
MO163511Medicaid