Provider Demographics
NPI:1265285530
Name:RENEW WELLNESS AND RECOVERY LLC
Entity type:Organization
Organization Name:RENEW WELLNESS AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TINYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:772-302-9769
Mailing Address - Street 1:1814 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7234
Mailing Address - Country:US
Mailing Address - Phone:772-208-8600
Mailing Address - Fax:
Practice Address - Street 1:1814 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-7234
Practice Address - Country:US
Practice Address - Phone:772-208-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty