Healthcare Provider Details

I. General information

NPI: 1265358071
Provider Name (Legal Business Name): RENOVABRIDGE COMMUNITY SERVICES L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 WILSON ST
MANCHESTER NH
03103-5024
US

IV. Provider business mailing address

198 WILSON ST
MANCHESTER NH
03103-5024
US

V. Phone/Fax

Practice location:
  • Phone: 603-820-6754
  • Fax:
Mailing address:
  • Phone: 603-820-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID AYAYA
Title or Position: MANAGING MEMBER
Credential:
Phone: 603-820-6754