Provider Demographics
NPI:1801365648
Name:RENEWED HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:RENEWED HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMEIL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-452-8563
Mailing Address - Street 1:4175 S CONGRESS AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4725
Mailing Address - Country:US
Mailing Address - Phone:561-331-8633
Mailing Address - Fax:561-600-1494
Practice Address - Street 1:4175 S CONGRESS AVE STE D
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4725
Practice Address - Country:US
Practice Address - Phone:561-331-8633
Practice Address - Fax:561-600-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-22
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001216600Medicaid