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General NPI Number Information
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NPI Number | 1063027951
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Entity Type | Organization
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Legal Business Name | RENEWED HEALTH CARE PRACTICE
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 2720 E 3RD ST
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City | DAYTON
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State | OH
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Zip | 45403-2102
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Country | US
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Telephone | 937-815-1911
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Fax | 937-630-3603
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Provider Business Mailing Address
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Address Line | 1101 LARONA RD
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City | TROTWOOD
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State | OH
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Zip | 45426-2574
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Country | US
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Telephone | 937-520-7889
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RHONDA FELECIA SMITH
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Credential | ALP
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Telephone | 937-520-7889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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