Provider Demographics
NPI:1508436387
Name:RELAX RENEW REJUVENATE LLC
Entity Type:Organization
Organization Name:RELAX RENEW REJUVENATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MCKINLEY
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-710-9895
Mailing Address - Street 1:PO BOX 2962
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-2962
Mailing Address - Country:US
Mailing Address - Phone:919-710-9895
Mailing Address - Fax:919-205-1532
Practice Address - Street 1:3560 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9495
Practice Address - Country:US
Practice Address - Phone:919-710-9895
Practice Address - Fax:919-205-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty