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General NPI Number Information
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NPI Number | 1881493799
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Entity Type | Organization
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Legal Business Name | RENEWED RADIANCE
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1203 EAST CORNERVIEW STREET
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City | GONZALES
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State | LA
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Zip | 70737
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Country | US
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Telephone | 833-357-3639
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Fax |
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Provider Business Mailing Address
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Address Line | 5256 FAULKNER DR
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City | DARROW
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State | LA
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Zip | 70725-2526
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Country | US
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Telephone | 225-323-6873
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Fax |
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Authorized Official
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Title or Position | OWNER/ MANGER
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Name | CARMESHA HARRIS
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Credential |
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Telephone | 833-357-3639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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