Healthcare Provider Details

I. General information

NPI: 1609554948
Provider Name (Legal Business Name): REJUVENATING EDUCATIONAL BEHAVIORAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 GATEWOOD DR
ALBANY GA
31705-6306
US

IV. Provider business mailing address

219 GATEWOOD DR
ALBANY GA
31705-6306
US

V. Phone/Fax

Practice location:
  • Phone: 229-485-9173
  • Fax:
Mailing address:
  • Phone: 229-485-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK PARKER
Title or Position: VICE PRESIDENT
Credential:
Phone: 229-894-3948