Healthcare Provider Details

I. General information

NPI: 1063027951
Provider Name (Legal Business Name): RENEWED HEALTH CARE PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E 3RD ST
DAYTON OH
45403-2102
US

IV. Provider business mailing address

1101 LARONA RD
TROTWOOD OH
45426-2574
US

V. Phone/Fax

Practice location:
  • Phone: 937-815-1911
  • Fax: 937-630-3603
Mailing address:
  • Phone: 937-520-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHONDA FELECIA SMITH
Title or Position: DIRECTOR
Credential: ALP
Phone: 937-520-7889