Healthcare Provider Details

I. General information

NPI: 1558930370
Provider Name (Legal Business Name): RENEW WOUND CARE OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 GLANZMAN RD
TOLEDO OH
43614-3802
US

IV. Provider business mailing address

1481 MCDONALD AVE
BROOKLYN NY
11230-4667
US

V. Phone/Fax

Practice location:
  • Phone: 929-491-7700
  • Fax:
Mailing address:
  • Phone: 929-491-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA POWELL
Title or Position: BOARD MEMBER
Credential:
Phone: 929-491-7700