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General NPI Number Information
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NPI Number | 1598472128
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Entity Type | Organization
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Legal Business Name | RENEW HEALTH SYSTEM & COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1033 LITTLE GULL DR
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City | FORNEY
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State | TX
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Zip | 75126-7768
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Country | US
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Telephone | 310-343-9965
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 LITTLE GULL DR
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City | FORNEY
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State | TX
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Zip | 75126-7768
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Country | US
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Telephone | 310-343-9965
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOLANGE-BELLE BOMA ANYU
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Credential |
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Telephone | 310-343-9965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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