Provider Demographics
NPI:1811571730
Name:REJUVENATE PSC
Entity Type:Organization
Organization Name:REJUVENATE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:RENANDO
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-524-9818
Mailing Address - Street 1:12390 SHERBURNE AVE # 110
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-9147
Mailing Address - Country:US
Mailing Address - Phone:612-524-9818
Mailing Address - Fax:
Practice Address - Street 1:12390 SHERBURNE AVE # 110
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-9147
Practice Address - Country:US
Practice Address - Phone:612-524-9818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE