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General NPI Number Information
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NPI Number | 1760636500
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Entity Type | Organization
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Legal Business Name | REJUVENATING ADULT DAY CARE
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 1023 N PINE ST BLDG 4
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City | SAN ANTONIO
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State | TX
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Zip | 78202-1203
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Country | US
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Telephone | 210-214-0349
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Fax | 210-595-7180
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Provider Business Mailing Address
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Address Line | 1023 N PINE ST BLDG 4
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City | SAN ANTONIO
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State | TX
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Zip | 78202-1203
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Country | US
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Telephone | 210-214-0349
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Fax | 210-595-7180
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Authorized Official
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Title or Position | PRESIDENT
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Name | L'KIENDRIA JOHNSON
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Credential |
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Telephone | 210-214-0349
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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 | TX
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