Provider Demographics
NPI:1790060473
Name:REJUVENATE HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:REJUVENATE HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARI DEE SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CID
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:858-344-5658
Mailing Address - Street 1:9087 ARROW RTE STE 284
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4478
Mailing Address - Country:US
Mailing Address - Phone:909-987-6500
Mailing Address - Fax:909-987-8500
Practice Address - Street 1:9087 ARROW RTE STE 284
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4478
Practice Address - Country:US
Practice Address - Phone:909-987-6500
Practice Address - Fax:909-987-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based