Provider Demographics
NPI:1619534120
Name:REJUVENATING WOMEN
Entity type:Organization
Organization Name:REJUVENATING WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-345-4673
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-0207
Mailing Address - Country:US
Mailing Address - Phone:402-345-4673
Mailing Address - Fax:
Practice Address - Street 1:3507 HARNEY ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3915
Practice Address - Country:US
Practice Address - Phone:402-345-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness