Provider Demographics
NPI:1609137843
Name:ACCESS HEALTH RENEWAL
Entity Type:Organization
Organization Name:ACCESS HEALTH RENEWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-865-5520
Mailing Address - Street 1:174 SO. FREEPORT ROAD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032
Mailing Address - Country:US
Mailing Address - Phone:207-865-5520
Mailing Address - Fax:866-270-1070
Practice Address - Street 1:174 SO. FREEPORT ROAD
Practice Address - Street 2:SUITE 2A
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032
Practice Address - Country:US
Practice Address - Phone:207-865-5520
Practice Address - Fax:866-270-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center