Provider Demographics
NPI:1154404242
Name:RENEWAL, INC
Entity type:Organization
Organization Name:RENEWAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-719-9900
Mailing Address - Street 1:225 CANDLER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6023
Mailing Address - Country:US
Mailing Address - Phone:912-819-5793
Mailing Address - Fax:912-819-5770
Practice Address - Street 1:225 CANDLER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6023
Practice Address - Country:US
Practice Address - Phone:912-819-5793
Practice Address - Fax:912-819-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherFED EMPLOYEE TAX ID