Provider Demographics
NPI:1457733164
Name:RENEWED VITALITY HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:RENEWED VITALITY HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:314-889-0153
Mailing Address - Street 1:7750 CLAYTON RD STE 302B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1341
Mailing Address - Country:US
Mailing Address - Phone:314-899-0153
Mailing Address - Fax:314-529-3431
Practice Address - Street 1:7750 CLAYTON RD STE 302B
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1341
Practice Address - Country:US
Practice Address - Phone:314-899-0153
Practice Address - Fax:314-529-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health