Provider Demographics
NPI:1336808831
Name:RENEW HEALTH LLC
Entity Type:Organization
Organization Name:RENEW HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP, CARN-AP
Authorized Official - Phone:575-363-3189
Mailing Address - Street 1:207 N UNION AVE STE E
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3068
Mailing Address - Country:US
Mailing Address - Phone:575-363-3189
Mailing Address - Fax:
Practice Address - Street 1:207 N UNION AVE STE E
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3068
Practice Address - Country:US
Practice Address - Phone:940-399-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty