Provider Demographics
NPI:1760221816
Name:RENUMI HAIR
Entity type:Organization
Organization Name:RENUMI HAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIC SUPPLIER
Authorized Official - Prefix:
Authorized Official - First Name:RAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-498-5207
Mailing Address - Street 1:1148 CLARENCE MCKEITHEN RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-8774
Mailing Address - Country:US
Mailing Address - Phone:919-498-5207
Mailing Address - Fax:
Practice Address - Street 1:1148 CLARENCE MCKEITHEN RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-8774
Practice Address - Country:US
Practice Address - Phone:919-498-5207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier