Provider Demographics
NPI:1598454894
Name:RE-NU MENTAL WELLNESS CENTER
Entity Type:Organization
Organization Name:RE-NU MENTAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESHAUNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,PMHNP
Authorized Official - Phone:954-295-0219
Mailing Address - Street 1:1000 W MCNAB RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4719
Mailing Address - Country:US
Mailing Address - Phone:954-440-7858
Mailing Address - Fax:954-405-8606
Practice Address - Street 1:1000 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4719
Practice Address - Country:US
Practice Address - Phone:954-440-7858
Practice Address - Fax:954-405-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty