Provider Demographics
NPI:1710650882
Name:RENU WELLNESS CENTERS, LLC.
Entity Type:Organization
Organization Name:RENU WELLNESS CENTERS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-549-2941
Mailing Address - Street 1:1220 VALLEY FORGE RD STE 23
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2676
Mailing Address - Country:US
Mailing Address - Phone:832-549-2941
Mailing Address - Fax:
Practice Address - Street 1:8839 BRYAN DAIRY RD STE 215
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1207
Practice Address - Country:US
Practice Address - Phone:727-851-9804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain