Provider Demographics
NPI:1760654511
Name:RENEWED POWER FOR LIVING CORP
Entity Type:Organization
Organization Name:RENEWED POWER FOR LIVING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPATES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:336-671-4779
Mailing Address - Street 1:1955 CAMDEN FOREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-4750
Mailing Address - Country:US
Mailing Address - Phone:336-671-4779
Mailing Address - Fax:336-331-3316
Practice Address - Street 1:1955 CAMDEN FOREST DRIVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-4750
Practice Address - Country:US
Practice Address - Phone:336-671-4779
Practice Address - Fax:336-331-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management