Provider Demographics
NPI:1053446096
Name:RENEWAL , INC
Entity Type:Organization
Organization Name:RENEWAL , INC
Other - Org Name:SECOND TO NATURE WOMEN'S BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-774-4155
Mailing Address - Street 1:818 SAINT SEBASTIAN WAY
Mailing Address - Street 2:STE 205
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2651
Mailing Address - Country:US
Mailing Address - Phone:706-774-4155
Mailing Address - Fax:706-774-4150
Practice Address - Street 1:818 SAINT SEBASTIAN WAY
Practice Address - Street 2:STE 205
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2651
Practice Address - Country:US
Practice Address - Phone:706-774-4155
Practice Address - Fax:706-774-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier