Provider Demographics
NPI:1114355146
Name:RENEW LIFE HOME HEALTHCARE AGENCY
Entity Type:Organization
Organization Name:RENEW LIFE HOME HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELBEAUTY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-712-5058
Mailing Address - Street 1:3610 HUNTSVILLE RD
Mailing Address - Street 2:APT. C3
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-712-5058
Mailing Address - Fax:
Practice Address - Street 1:3610 HUNTSVILLE RD
Practice Address - Street 2:APT. C3
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4069
Practice Address - Country:US
Practice Address - Phone:256-712-5058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health