Provider Demographics
NPI:1699309963
Name:CKAM REJUVENATION CENTER LLC
Entity type:Organization
Organization Name:CKAM REJUVENATION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARLA
Authorized Official - Middle Name:MARKAEL
Authorized Official - Last Name:BORNHOFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-263-3211
Mailing Address - Street 1:30410 HIGHWAY 200 STE 100
Mailing Address - Street 2:
Mailing Address - City:PONDERAY
Mailing Address - State:ID
Mailing Address - Zip Code:83852-9601
Mailing Address - Country:US
Mailing Address - Phone:208-627-9687
Mailing Address - Fax:
Practice Address - Street 1:30410 HIGHWAY 200 STE 100
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9601
Practice Address - Country:US
Practice Address - Phone:208-263-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty