Provider Demographics
NPI:1063027951
Name:RENEWED HEALTH CARE PRACTICE
Entity Type:Organization
Organization Name:RENEWED HEALTH CARE PRACTICE
Other - Org Name:RENEWED HEALTH CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:FELECIA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ALP
Authorized Official - Phone:937-520-7889
Mailing Address - Street 1:1101 LARONA RD
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2574
Mailing Address - Country:US
Mailing Address - Phone:937-520-7889
Mailing Address - Fax:
Practice Address - Street 1:1101 LARONA RD
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2574
Practice Address - Country:US
Practice Address - Phone:193-752-0788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center