| The Rejuvenation House Medi-spa Llc | |
|
144 E Us Highway 30 Schererville IN 46375-2117 | |
| (219) 515-2667 | |
| Not Available |
| Full Name | The Rejuvenation House Medi-spa Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 144 E Us Highway 30, Schererville, Indiana |
| Authorized Official Name and Position | Brittney Bennett (OWNER) |
| Authorized Official Contact | 2193081589 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Rejuvenation House Medi-spa Llc 144 E Us Highway 30 Schererville IN 46375-2117 Ph: (219) 515-2667 | The Rejuvenation House Medi-spa Llc 144 E Us Highway 30 Schererville IN 46375-2117 Ph: (219) 515-2667 |
| NPI Number | 1003560285 |
|---|---|
| Provider Enumeration Date | 02/07/2022 |
| Last Update Date | 04/14/2022 |
| Medicare PECOS PAC ID | 5799171393 |
|---|---|
| Medicare Enrollment ID | O20220407001818 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003560285 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Clive L Alonzo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134190721 PECOS PAC ID: 7012935919 Enrollment ID: I20051109000701 |
| Provider Name | Brittney Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386174530 PECOS PAC ID: 5294000451 Enrollment ID: I20171013002666 |
| Provider Name | Dana Hiskes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346707957 PECOS PAC ID: 7214277169 Enrollment ID: I20190313000345 |
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