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General NPI Number Information
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NPI Number | 1346480738
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Entity Type | Organization
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Legal Business Name | REJUVENATE REHABILITATION CENTER
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 300 GRAND AVE SUITE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4398
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Country | US
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Telephone | 201-408-5525
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Fax | 201-408-5526
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Provider Business Mailing Address
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Address Line | 300 GRAND AVE SUITE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4398
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Country | US
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Telephone | 201-408-5525
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Fax | 201-408-5526
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Authorized Official
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Title or Position | OWNER
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Name | MR. VALENTINE DIVINA VILLARBA
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Credential | RPT
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Telephone | 201-334-6991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA01187800
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License Number State | NJ
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