Provider Demographics
NPI:1043987266
Name:RENEWED LIFE THERAPY
Entity Type:Organization
Organization Name:RENEWED LIFE THERAPY
Other - Org Name:RENEWED LIFE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SINDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:352-875-3029
Mailing Address - Street 1:4572 SW 44TH CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4345
Mailing Address - Country:US
Mailing Address - Phone:352-875-3029
Mailing Address - Fax:
Practice Address - Street 1:1515 E SILVER SPRINGS BLVD # 147-2
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6831
Practice Address - Country:US
Practice Address - Phone:352-875-3029
Practice Address - Fax:352-877-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health