Provider Demographics
NPI:1013630201
Name:RENEWED HEALTH, LLC
Entity Type:Organization
Organization Name:RENEWED HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-503-6999
Mailing Address - Street 1:8503 PATTERSON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6442
Mailing Address - Country:US
Mailing Address - Phone:804-503-6999
Mailing Address - Fax:
Practice Address - Street 1:1603 SANTA ROSA RD RM 203
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5010
Practice Address - Country:US
Practice Address - Phone:804-905-6998
Practice Address - Fax:804-404-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty