Healthcare Provider Details

I. General information

NPI: 1730004839
Provider Name (Legal Business Name): REJUVENATION CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 BAUMAN AVE
OMAHA NE
68112-3311
US

IV. Provider business mailing address

1023 JONES ST APT 902
OMAHA NE
68102-2937
US

V. Phone/Fax

Practice location:
  • Phone: 402-637-5166
  • Fax:
Mailing address:
  • Phone: 402-637-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: FRANK LOUIS BAILEY III
Title or Position: PROGRAM CREATOR
Credential: LADC, LMHP, LPC
Phone: 402-637-5166