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General NPI Number Information
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NPI Number | 1639740327
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Entity Type | Organization
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Legal Business Name | SIMPLY RENEW
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Dates
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Enumeration Date | 07/05/2021
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Last Update Date | 07/05/2021
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Provider Practice Location Address
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Address Line | 10785 YANKEE ST
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City | DAYTON
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State | OH
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Zip | 45458-3572
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Country | US
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Telephone | 937-267-5799
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Fax |
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Provider Business Mailing Address
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Address Line | 700 BANBURY RD
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City | DAYTON
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State | OH
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Zip | 45459-1650
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Country | US
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Telephone | 937-267-6799
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARA EDWARDS
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Credential |
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Telephone | 937-267-6799
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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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