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NPI Code Detail

MEDICARE: REJUVEN HEALTH LV

MEDICARE: REJUVEN HEALTH LV
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QC1500XCommunity Health Clinic/Center
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1164279972
Entity Type Code : Organization
Provider Name (Legal Business Name) : REJUVEN HEALTH LV
Provider Business Mailing Address
First Line : 42 MEGAN DR
Second Line :
City : HENDERSON
State : NV
Zip : 89074-2774
Country : US
Telephone Number : 405-881-6822
Fax Number :
Provider Business Practice Location Address
First Line : 129 W LAKE MEAD PKWY STE 8
Second Line :
City : HENDERSON
State : NV
Zip : 89015-7055
Country : US
Telephone Number : 725-264-8686
Fax Number : 877-409-1697
Authorized Official
Title or Position : CEO
Name : LENA NGUYEN
Credential : APRN
Telephone Number : 405-881-6822
Provider Enumeration Date : 05/01/2024
Last Update Date : 12/08/2024

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