Provider Demographics
NPI:1881397388
Name:RENEWING LIFE
Entity type:Organization
Organization Name:RENEWING LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:TOVES
Authorized Official - Last Name:SAN NICOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-517-3239
Mailing Address - Street 1:1058 CAMINO DEL REY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7053
Mailing Address - Country:US
Mailing Address - Phone:619-517-3239
Mailing Address - Fax:
Practice Address - Street 1:1058 CAMINO DEL REY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7053
Practice Address - Country:US
Practice Address - Phone:619-517-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)