Provider Demographics
NPI:1003603119
Name:VITREOUS RENEW PATH
Entity type:Organization
Organization Name:VITREOUS RENEW PATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PRINCESS 1
Authorized Official - Middle Name:MERICLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-603-2324
Mailing Address - Street 1:5505 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-1992
Mailing Address - Country:US
Mailing Address - Phone:515-603-2324
Mailing Address - Fax:
Practice Address - Street 1:5505 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-1992
Practice Address - Country:US
Practice Address - Phone:515-603-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty