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General NPI Number Information
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NPI Number | 1003760679
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Entity Type | Organization
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Legal Business Name | REJUVENATE RESIDENTIAL SERVICES LLC
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 1904 E 22ND ST
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City | MUNCIE
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State | IN
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Zip | 47302-5466
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Country | US
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Telephone | 765-273-3391
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Fax |
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Provider Business Mailing Address
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Address Line | 5112 N HICKORY RD
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City | MUNCIE
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State | IN
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Zip | 47303-1074
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOMINYSE DAVIS
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Credential | DNP, APRN, FNP PMHNC
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Telephone | 317-985-3580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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