MEDICARE: RENEW HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	104100000X	Social Worker
3	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1336808831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW HEALTH LLC

Provider Business Mailing Address
First Line	:	207 N UNION AVE STE E
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-3068
Country	:	US
Telephone Number	:	575-363-3189
Fax Number	:	575-363-3088

Provider Business Practice Location Address
First Line	:	207 N UNION AVE STE E
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-3068
Country	:	US
Telephone Number	:	940-399-6165
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT TRENT CARTER
Credential	:	APRN, CARN-AP
Telephone Number	:	575-363-3189

Provider Enumeration Date	:	12/12/2021
Last Update Date	:	03/16/2026

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Directions to “RENEW HEALTH LLC ” Practice Location

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