Provider Demographics
NPI:1639641319
Name:BALA, RENU
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:
Last Name:BALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENU
Other - Middle Name:
Other - Last Name:CHADDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4375 RIDGE CREST DR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3065
Mailing Address - Country:US
Mailing Address - Phone:216-544-7385
Mailing Address - Fax:
Practice Address - Street 1:801 E WASHINGTON ST STE 150
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3336
Practice Address - Country:US
Practice Address - Phone:330-722-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator