Provider Demographics
NPI:1831877273
Name:REJUVENTATE AK
Entity type:Organization
Organization Name:REJUVENTATE AK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-631-3015
Mailing Address - Street 1:PO BOX 874486
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4486
Mailing Address - Country:US
Mailing Address - Phone:907-841-2565
Mailing Address - Fax:
Practice Address - Street 1:2405 S KNIK GOOSE BAY ROAD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-841-2565
Practice Address - Fax:907-841-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty