Provider Demographics
NPI:1801155486
Name:RENUVA HEALTH LLC
Entity type:Organization
Organization Name:RENUVA HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE D.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-667-2829
Mailing Address - Street 1:4400 COLLEGE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2326
Mailing Address - Country:US
Mailing Address - Phone:913-667-2298
Mailing Address - Fax:816-525-9052
Practice Address - Street 1:4400 COLLEGE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2326
Practice Address - Country:US
Practice Address - Phone:913-667-2298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center