MEDICARE: RENEWED HEALTH CARE PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1063027951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED HEALTH CARE PRACTICE

Provider Business Mailing Address
First Line	:	1101 LARONA RD
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-2574
Country	:	US
Telephone Number	:	937-520-7889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 E 3RD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-2102
Country	:	US
Telephone Number	:	937-815-1911
Fax Number	:	937-630-3603

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RHONDA FELECIA SMITH
Credential	:	ALP
Telephone Number	:	937-520-7889

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	01/14/2025

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Directions to “RENEWED HEALTH CARE PRACTICE ” Practice Location

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