Healthcare Provider Details

I. General information

NPI: 1336808831
Provider Name (Legal Business Name): RENEW HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2021
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N UNION AVE STE E
ROSWELL NM
88201-3068
US

IV. Provider business mailing address

207 N UNION AVE STE E
ROSWELL NM
88201-3068
US

V. Phone/Fax

Practice location:
  • Phone: 940-399-6165
  • Fax:
Mailing address:
  • Phone: 575-363-3189
  • Fax: 575-363-3088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT TRENT CARTER
Title or Position: OWNER
Credential: APRN, CARN-AP
Phone: 575-363-3189