Organization Active NPI

Renewed Brain Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mineral Point, WI
National Provider Identifier
1790515765
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
RENEWED BRAIN HEALTH LLC
Practice address
122 High St
Mineral Point, WI 53565-1287
Phone
(608) 778-6833
Fax
(608) 305-8956
NPI assigned
Aug 5, 2024
Last updated
Aug 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Cecelia Greenwood, LCSWNPI 1689262628
Title
Owner
Phone
(608) 778-6833

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

122 High St
Mineral Point, WI 53565-1287

Mailing address

122 High St
Mineral Point, WI 53565-1287
Phone (608) 778-6833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240909000829 WI Part B Supplier - Clinic/Group Practice 0446790281 Receives reassigned benefits from 2 practitioners
Practice locations: Mineral Point, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1790515765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 HIGH ST",
            "city": "MINERAL POINT",
            "state": "WI",
            "postal_code": "535651287",
            "telephone_number": "608-778-6833",
            "fax_number": "608-305-8956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 HIGH ST",
            "city": "MINERAL POINT",
            "state": "WI",
            "postal_code": "535651287",
            "telephone_number": "608-778-6833",
            "fax_number": "608-305-8956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEWED BRAIN HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "GREENWOOD",
        "authorized_official_first_name": "CECELIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-778-6833",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineral Point, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; 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.