NPIMap

Organization Active NPI

Rejuvenate Psychiatric Mental Health Services, LLC

  • Community/Behavioral Health Agency
  • Peabody, MA
National Provider Identifier
1982305116
Registry record updated Mar 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
REJUVENATE PSYCHIATRIC MENTAL HEALTH SERVICES, LLC
Practice address
100 Corporate PL Ste 303
Peabody, MA 01960-3809
Phone
(781) 640-1791
NPI assigned
Mar 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Edwin Agbonavbare, MSNNPI 1386007631
Title
CNP
Phone
(781) 640-1791

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

100 Corporate PL Ste 303
Peabody, MA 01960-3809

Mailing address

100 Corporate PL Ste 303
Peabody, MA 01960-3809

National Provider Directory

National Provider Directory

Locations

100 Corporate Pl
Ste 303
Peabody, MA 01960
Phone (781) 640-1791

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678838400000",
    "number": "1982305116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CORPORATE PL STE 303",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019603809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CORPORATE PL STE 303",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019603809",
            "telephone_number": "781-640-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVENATE PSYCHIATRIC MENTAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-14",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A",
        "authorized_official_last_name": "AGBONAVBARE",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "CNP",
        "authorized_official_telephone_number": "781-640-1791",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.