Healthcare Provider Details

I. General information

NPI: 1497854137
Provider Name (Legal Business Name): THE RENFREW CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 E. PUTNAM AVENUE 1ST FLOOR
OLD GREENWICH CT
06870
US

IV. Provider business mailing address

8945 RIDGE AVENUE #R
PHILADELPHIA PA
19128
US

V. Phone/Fax

Practice location:
  • Phone: 203-834-5020
  • Fax: 203-563-9936
Mailing address:
  • Phone: 215-482-5353
  • Fax: 215-487-3972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number0000-0036
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL E. MENAGED
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 215-482-5353