Provider Demographics
NPI:1215571468
Name:RENEW HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:RENEW HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:218-966-0450
Mailing Address - Street 1:2932 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2564
Mailing Address - Country:US
Mailing Address - Phone:218-966-0450
Mailing Address - Fax:218-440-2069
Practice Address - Street 1:2932 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2564
Practice Address - Country:US
Practice Address - Phone:218-966-0450
Practice Address - Fax:218-440-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)