Provider Demographics
NPI:1568015246
Name:RENEW HEALTH LLC
Entity Type:Organization
Organization Name:RENEW HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:480-215-9003
Mailing Address - Street 1:426 E SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5215
Mailing Address - Country:US
Mailing Address - Phone:480-681-7979
Mailing Address - Fax:480-247-4103
Practice Address - Street 1:426 E SOUTHERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5215
Practice Address - Country:US
Practice Address - Phone:480-681-7979
Practice Address - Fax:480-247-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty