Provider Demographics
NPI:1407540057
Name:RENFROE, PRECIOUS
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:
Last Name:RENFROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-1071
Mailing Address - Country:US
Mailing Address - Phone:330-618-7583
Mailing Address - Fax:
Practice Address - Street 1:1239 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-1071
Practice Address - Country:US
Practice Address - Phone:330-618-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide