Healthcare Provider Details

I. General information

NPI: 1164514691
Provider Name (Legal Business Name): THE RENFREW CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KALISA WAY SUITE 211
PARAMUS NJ
07652
US

IV. Provider business mailing address

1 KALISA WAY SUITE 211
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-652-5114
  • Fax: 201-625-6253
Mailing address:
  • Phone: 201-652-5114
  • Fax: 201-625-6253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/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 TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number100930104
License Number StateNJ

VIII. Authorized Official

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