Provider Demographics
NPI:1346629714
Name:RENEWAL SPRINGS OF HOPE OUTREACH
Entity Type:Organization
Organization Name:RENEWAL SPRINGS OF HOPE OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLEEP SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WARDELL
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:III
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:713-459-0512
Mailing Address - Street 1:2628 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7611
Mailing Address - Country:US
Mailing Address - Phone:713-498-6523
Mailing Address - Fax:
Practice Address - Street 1:2628 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7611
Practice Address - Country:US
Practice Address - Phone:713-498-6523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21356247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty