Provider Demographics
NPI:1255835062
Name:RENOVO NATURAL HEALTH LLC
Entity Type:Organization
Organization Name:RENOVO NATURAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LONARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PSCD, TND
Authorized Official - Phone:919-986-9940
Mailing Address - Street 1:6512 SIX FORKS RD STE 404A
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6526
Mailing Address - Country:US
Mailing Address - Phone:919-986-9940
Mailing Address - Fax:919-977-0762
Practice Address - Street 1:4940 WINDY HILL DR STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5278
Practice Address - Country:US
Practice Address - Phone:919-986-9940
Practice Address - Fax:919-977-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center