Provider Demographics
NPI:1528591773
Name:RENOVIA INC
Entity Type:Organization
Organization Name:RENOVIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR REIMBURSEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-560-8626
Mailing Address - Street 1:99 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2320
Mailing Address - Country:US
Mailing Address - Phone:617-851-7093
Mailing Address - Fax:617-439-9707
Practice Address - Street 1:99 HIGH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2320
Practice Address - Country:US
Practice Address - Phone:617-851-7093
Practice Address - Fax:617-439-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies