MEDICARE: RENEW CONSULTING, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	DD2701	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881931798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW CONSULTING, INC.

Provider Business Mailing Address
First Line	:	808 OLD SALEM RD NE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-4539
Country	:	US
Telephone Number	:	541-905-7236
Fax Number	:	541-981-2127

Provider Business Practice Location Address
First Line	:	3415 COLUMBIA VIEW DR
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-9703
Country	:	US
Telephone Number	:	541-905-7236
Fax Number	:	541-981-2127

Authorized Official
Title or Position	:	OWNER
Name	:	KATHY ARONSON
Credential	:
Telephone Number	:	503-851-8219

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	01/11/2013

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