Provider Demographics
NPI:1437668530
Name:REJUVECARE CLINIC INC
Entity type:Organization
Organization Name:REJUVECARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-203-5174
Mailing Address - Street 1:1300 S RESERVE ST STE H
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4704
Mailing Address - Country:US
Mailing Address - Phone:406-203-5174
Mailing Address - Fax:406-926-1044
Practice Address - Street 1:1300 S RESERVE ST STE H
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4704
Practice Address - Country:US
Practice Address - Phone:406-203-5174
Practice Address - Fax:406-926-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty