=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174489017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REJUVEN WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 568 E STATE ST
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44460-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-271-0461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43522 METZ RD
-----------------------------------------------------
City | COLUMBIANA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44408-9474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-420-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KARA GLICK
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 330-420-8300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------