Healthcare Provider Details

I. General information

NPI: 1649609181
Provider Name (Legal Business Name): CLIFFORD RENCHEN ACSM HFS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 DEVERS RD
RICHMOND VA
23226-2807
US

IV. Provider business mailing address

1700 DEVERS RD
RICHMOND VA
23226-2807
US

V. Phone/Fax

Practice location:
  • Phone: 910-389-2038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: