MEDICARE: RENU

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	251S00000X	Community/Behavioral Health Agency		NV

General Provider Information

NPI Number	:	1639457799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENU

Provider Business Mailing Address
First Line	:	2500 PERLITER AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7309
Country	:	US
Telephone Number	:	702-542-5873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 PERLITER AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7309
Country	:	US
Telephone Number	:	702-542-5873
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JEQUETTA L BELLARD
Credential	:
Telephone Number	:	702-542-5873

Provider Enumeration Date	:	07/23/2011
Last Update Date	:	07/23/2011

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Directions to “RENU ” Practice Location

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