Healthcare Provider Details

I. General information

NPI: 1851235147
Provider Name (Legal Business Name): RENEWED SPIRIT RESIDENCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8149 E POSADA AVE
MESA AZ
85212-1667
US

IV. Provider business mailing address

8149 E POSADA AVE
MESA AZ
85212-1667
US

V. Phone/Fax

Practice location:
  • Phone: 623-312-5465
  • Fax:
Mailing address:
  • Phone: 623-312-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL BURRUSS
Title or Position: OWNER/CEO, EMPLOYEE
Credential:
Phone: 623-312-5465