| The Rejuvenation Space Llc | |
|
230 40th St Irvington NJ 07111-1149 | |
| (646) 633-5595 | |
| Not Available |
| Full Name | The Rejuvenation Space Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 230 40th St, Irvington, New Jersey |
| Authorized Official Name and Position | Chrystal Renee Allen (BUSINESS OWNER) |
| Authorized Official Contact | 6466335595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Rejuvenation Space Llc 230 40th St Irvington NJ 07111-1149 Ph: (646) 633-5595 | The Rejuvenation Space Llc 230 40th St Irvington NJ 07111-1149 Ph: (646) 633-5595 |
| NPI Number | 1386273571 |
|---|---|
| Provider Enumeration Date | 04/08/2020 |
| Last Update Date | 04/15/2020 |
| Certification Date | 04/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386273571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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