Healthcare Provider Details

I. General information

NPI: 1346674215
Provider Name (Legal Business Name): THE RENFREW CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 R COMMONWEALTH AVENUE
BOSTON MA
02215
US

IV. Provider business mailing address

8945 RIDGE AVENUE #R
PHILADELPHIA PA
19128
US

V. Phone/Fax

Practice location:
  • Phone: 617-278-6380
  • Fax: 617-278-6386
Mailing address:
  • Phone: 215-482-5353
  • Fax: 215-487-3972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 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