Provider Demographics
NPI:1093689309
Name:REJUVENATE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:REJUVENATE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLUDAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OJELADE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:773-425-4345
Mailing Address - Street 1:3515 SUMAC DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-9019
Mailing Address - Country:US
Mailing Address - Phone:815-514-6887
Mailing Address - Fax:
Practice Address - Street 1:3515 SUMAC DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-9019
Practice Address - Country:US
Practice Address - Phone:815-514-6887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty