Provider Demographics
NPI:1063129963
Name:REJUVENATE HEALTH
Entity type:Organization
Organization Name:REJUVENATE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENTREMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-806-1168
Mailing Address - Street 1:2667 BELLEVUE LAKES DR
Mailing Address - Street 2:
Mailing Address - City:PAULINA
Mailing Address - State:LA
Mailing Address - Zip Code:70763-2383
Mailing Address - Country:US
Mailing Address - Phone:225-806-1168
Mailing Address - Fax:
Practice Address - Street 1:1935 LUTCHER AVE
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-7076
Practice Address - Country:US
Practice Address - Phone:225-806-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care