Provider Demographics
NPI:1073261889
Name:RENU 2 LLC
Entity Type:Organization
Organization Name:RENU 2 LLC
Other - Org Name:RENU 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESONIJA
Authorized Official - Middle Name:SHAVON
Authorized Official - Last Name:FULGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-494-6119
Mailing Address - Street 1:8010 BLAIR MILL WAY APT 207E
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-6805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8010 BLAIR MILL WAY APT 207E
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6805
Practice Address - Country:US
Practice Address - Phone:202-494-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty