MEDICARE: RENEWLIFE HEALTH CARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1609149509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWLIFE HEALTH CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	8411 WEST BELLFORT ST.
Second Line	:	SUITE 110B
City	:	HOUSTON
State	:	TX
Zip	:	77071-2205
Country	:	US
Telephone Number	:	713-360-7095
Fax Number	:	713-360-7160

Provider Business Practice Location Address
First Line	:	8411 W BELLFORT ST
Second Line	:	SUITE 110B
City	:	HOUSTON
State	:	TX
Zip	:	77071-2205
Country	:	US
Telephone Number	:	713-360-7095
Fax Number	:	713-360-7160

Authorized Official
Title or Position	:	EXECUTIVE PROGRAM DIRECTOR
Name	:	MS. GLORIA FRANCIS
Credential	:
Telephone Number	:	713-360-7095

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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