Provider Demographics
NPI:1548939499
Name:REJUVENATING HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:REJUVENATING HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP AND RN
Authorized Official - Prefix:
Authorized Official - First Name:KAMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, AGPCNP-BC
Authorized Official - Phone:901-484-9099
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-0515
Mailing Address - Country:US
Mailing Address - Phone:901-484-9099
Mailing Address - Fax:470-222-2771
Practice Address - Street 1:8254 WEATHERWOOD LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6344
Practice Address - Country:US
Practice Address - Phone:901-484-9099
Practice Address - Fax:470-222-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home