Healthcare Provider Details

I. General information

NPI: 1699609479
Provider Name (Legal Business Name): RISE AND RENEW LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4329 CROWNWOOD AVE
DAYTON OH
45415-1405
US

IV. Provider business mailing address

4329 CROWNWOOD AVE
DAYTON OH
45415-1405
US

V. Phone/Fax

Practice location:
  • Phone: 937-794-4662
  • Fax: 937-794-4662
Mailing address:
  • Phone: 937-794-4662
  • Fax: 937-794-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: CLASHAE ALLEN
Title or Position: OWNER
Credential: ALLEN
Phone: 937-794-4662