| Renew Wellness Llc | |
|
1281 E Iron Eagle Dr Eagle ID 83616-6599 | |
| (208) 912-4011 | |
| Not Available |
| Full Name | Renew Wellness Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1281 E Iron Eagle Dr, Eagle, Idaho |
| Authorized Official Name and Position | Malisa Williams (OWNER) |
| Authorized Official Contact | 2089124011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Wellness Llc 5650 N Dalspring Ave Boise ID 83713-1315 Ph: () - | Renew Wellness Llc 1281 E Iron Eagle Dr Eagle ID 83616-6599 Ph: (208) 912-4011 |
| NPI Number | 1316538663 |
|---|---|
| Provider Enumeration Date | 01/29/2021 |
| Last Update Date | 02/17/2021 |
| Certification Date | 02/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316538663 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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