1356753107 NPI number — RETNUH HEALTH LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356753107 NPI number — RETNUH HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETNUH HEALTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356753107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 W BROAD ST # 412
Provider Second Line Business Mailing Address:
RETNUH HEALTH, LLC
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22046-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-879-1856
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 W BROAD ST # 412
Provider Second Line Business Practice Location Address:
RETNUH HEALTH, LLC
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22046-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-879-1856
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
BELETA
Authorized Official Title or Position:
DIRECTOR, OWNER
Authorized Official Telephone Number:
888-879-1856

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  49D2067382 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 0206009831 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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