Provider Demographics
NPI:1386904845
Name:REJUV ROLLING MEADOWS PC
Entity type:Organization
Organization Name:REJUV ROLLING MEADOWS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:309-678-4243
Mailing Address - Street 1:101 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GOODFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61742-9502
Mailing Address - Country:US
Mailing Address - Phone:309-678-4243
Mailing Address - Fax:
Practice Address - Street 1:3501 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3103
Practice Address - Country:US
Practice Address - Phone:847-457-4378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095342261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center