Provider Demographics
NPI:1063777415
Name:RENEW HEALTHCARE LLC
Entity type:Organization
Organization Name:RENEW HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:ENGEL
Authorized Official - Last Name:KORT
Authorized Official - Suffix:
Authorized Official - Credentials:CNP, CNM, MPH
Authorized Official - Phone:503-269-3495
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:NEOTSU
Mailing Address - State:OR
Mailing Address - Zip Code:97364-0827
Mailing Address - Country:US
Mailing Address - Phone:503-269-3495
Mailing Address - Fax:
Practice Address - Street 1:2937 NW HIGHWAY 101
Practice Address - Street 2:SUITE 110
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4442
Practice Address - Country:US
Practice Address - Phone:541-614-0314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18043302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR049796OtherOMAP
OR049796Medicaid
OR049796OtherOMAP
OR049796Medicaid
OR049796Medicaid
ORP18696Medicare UPIN
016ZBBGAMedicare UPIN