Provider Demographics
NPI:1063027951
Name:RENEWED HEALTH CARE PRACTICE
Entity type:Organization
Organization Name:RENEWED HEALTH CARE PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:FELECIA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ALP
Authorized Official - Phone:937-520-7889
Mailing Address - Street 1:1101 LARONA RD
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2574
Mailing Address - Country:US
Mailing Address - Phone:937-520-7889
Mailing Address - Fax:
Practice Address - Street 1:2720 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2102
Practice Address - Country:US
Practice Address - Phone:937-815-1911
Practice Address - Fax:937-630-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center