Provider Demographics
NPI:1497462030
Name:REJUVEN8 HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:REJUVEN8 HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE-GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:985-214-2017
Mailing Address - Street 1:753 ROBERT BLVD # 1008
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1637
Mailing Address - Country:US
Mailing Address - Phone:985-214-2017
Mailing Address - Fax:985-202-8403
Practice Address - Street 1:753 ROBERT BLVD # 1008
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1637
Practice Address - Country:US
Practice Address - Phone:985-214-2017
Practice Address - Fax:985-202-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service