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General NPI Number Information
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NPI Number | 1255223566
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Entity Type | Organization
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Legal Business Name | REJUVENATE RECOVER RECREATE, LLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 2400 10TH AVE
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City | GREELEY
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State | CO
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Zip | 80631-6914
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Country | US
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Telephone | 719-663-4622
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 10TH AVE
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City | GREELEY
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State | CO
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Zip | 80631-6914
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Country | US
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Telephone | 719-663-4622
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELANIE ANN DOUGLASS
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Credential |
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Telephone | 719-663-6422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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