MEDICARE: COGNITIVE RENOVATIONS LLC

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	405300000X	Prevention Professional

General Provider Information

NPI Number	:	1952273807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COGNITIVE RENOVATIONS LLC

Provider Business Mailing Address
First Line	:	6830 SIMPSON AVE APT 7
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-4748
Country	:	US
Telephone Number	:	513-394-9056
Fax Number	:

Provider Business Practice Location Address
First Line	:	6830 SIMPSON AVE APT 7
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-4748
Country	:	US
Telephone Number	:	513-394-9056
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	WALI NEWTON
Credential	:
Telephone Number	:	513-394-9056

Provider Enumeration Date	:	09/20/2025
Last Update Date	:	09/20/2025

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