Innovative Renewal Therapy Center LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

INNOVATIVE RENEWAL THERAPY CENTER LLC

Practice address

73 Market St
Onancock, VA 23417-4223

Phone

(804) 657-7344

NPI assigned

Oct 23, 2018

Last updated

Oct 23, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edwana CottmanNPI 1164927448

Title

Owner

Phone

(804) 657-7344

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Edwana Cottman, LCSW-C

  • Clinical Social Worker
  • Salisbury, MD
  • NPI 1164927448

  VA

  Medicare reassignment NPD Authorized official
• Abigail Izetta Siegrist, LCSW

  • Clinical Social Worker
  • Onancock, VA
  • NPI 1346744158
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1689140063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 MARKET ST",
            "city": "ONANCOCK",
            "state": "VA",
            "postal_code": "234174223",
            "telephone_number": "804-657-7344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 MARKET ST",
            "city": "ONANCOCK",
            "state": "VA",
            "postal_code": "234174223",
            "telephone_number": "804-657-7344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE RENEWAL THERAPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "COTTMAN",
        "authorized_official_first_name": "EDWANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-657-7344"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Fisher Hare, RPA-C
• Crystal Harris, MSN, AGACNP C
• Deborah A. Heffron, RD, LDN
• Emory F Hurst Jr., RPH
• Robert Ingram, M.D.
• Intrepid of Delmarva, Inc. (Intrepid USA Healthcare Services)
• Intrepid of Virginia, Inc. (Intrepid USA Hospice)
• James J James, M.D.
• David Fitzgerald Jones, MD
• KC Sightseeing Outing

• Clinical Social Worker in Onancock, VA
• Providers in Onancock, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.