Provider Demographics
NPI:1790452043
Name:RENUE 018 TAWAS, LLC
Entity type:Organization
Organization Name:RENUE 018 TAWAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAPISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-450-3341
Mailing Address - Street 1:804 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5620
Mailing Address - Country:US
Mailing Address - Phone:989-450-3341
Mailing Address - Fax:989-778-1237
Practice Address - Street 1:540 W LAKE ST STE 3
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-5101
Practice Address - Country:US
Practice Address - Phone:989-984-6075
Practice Address - Fax:989-305-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790452043Medicaid