Provider Demographics
NPI:1881493799
Name:RENEWED RADIANCE
Entity type:Organization
Organization Name:RENEWED RADIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-357-3639
Mailing Address - Street 1:5256 FAULKNER DR
Mailing Address - Street 2:
Mailing Address - City:DARROW
Mailing Address - State:LA
Mailing Address - Zip Code:70725-2526
Mailing Address - Country:US
Mailing Address - Phone:225-323-6873
Mailing Address - Fax:
Practice Address - Street 1:1203 EAST CORNERVIEW STREET
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:833-357-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies