Healthcare Provider Details

I. General information

NPI: 1255223566
Provider Name (Legal Business Name): REJUVENATE RECOVER RECREATE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 10TH AVE
GREELEY CO
80631-6914
US

IV. Provider business mailing address

2400 10TH AVE
GREELEY CO
80631-6914
US

V. Phone/Fax

Practice location:
  • Phone: 719-663-4622
  • Fax:
Mailing address:
  • Phone: 719-663-4622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MELANIE ANN DOUGLASS
Title or Position: OWNER
Credential:
Phone: 719-663-6422