Provider Demographics
NPI:1821668054
Name:HEARTED REJUVENATION LLC
Entity Type:Organization
Organization Name:HEARTED REJUVENATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINGAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-348-5488
Mailing Address - Street 1:3175 COUNTY ROAD 2606
Mailing Address - Street 2:
Mailing Address - City:CADDO MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:75135-6269
Mailing Address - Country:US
Mailing Address - Phone:469-348-5488
Mailing Address - Fax:
Practice Address - Street 1:3175 COUNTY ROAD 2606
Practice Address - Street 2:
Practice Address - City:CADDO MILLS
Practice Address - State:TX
Practice Address - Zip Code:75135-6269
Practice Address - Country:US
Practice Address - Phone:469-348-5488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness